Difference between revisions of "Whipple's disease"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = Whipple disease - very high mag.jpg | ||
| Width = | | Width = | ||
| Caption = Whipple's disease. [[H&E stain]]. | | Caption = Whipple's disease. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = | ||
| Micro = | | Micro = rod-shaped microorganisms - typically in macrophages; lamina propria macrophages usually abundant | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[mycobacterium avium complex]] | | LMDDx = [[mycobacterium avium complex]] | ||
| Line 30: | Line 30: | ||
| Tx = antibiotics | | Tx = antibiotics | ||
}} | }} | ||
'''Whipple's disease''' is a rare infectious disease that is classically in the [[duodenum]]. | '''Whipple's disease''' is a rare infectious disease that is classically found in the [[duodenum]]. | ||
==General== | ==General== | ||
Etiology: | Etiology: | ||
*Infection - caused by ''Tropheryma whipplei''<ref name=pmid11777846>{{cite journal |author=Liang Z, La Scola B, Raoult D |title=Monoclonal antibodies to immunodominant epitope of Tropheryma whipplei |journal=Clin. Diagn. Lab. Immunol. |volume=9 |issue=1 |pages=156?9 |year=2002 |month=January |pmid=11777846 |pmc=119894 |doi= |url=http://cvi.asm.org/cgi/pmidlookup?view=long&pmid=11777846}}</ref> a rod-shaped | *Infection - caused by ''Tropheryma whipplei''<ref name=pmid11777846>{{cite journal |author=Liang Z, La Scola B, Raoult D |title=Monoclonal antibodies to immunodominant epitope of Tropheryma whipplei |journal=Clin. Diagn. Lab. Immunol. |volume=9 |issue=1 |pages=156?9 |year=2002 |month=January |pmid=11777846 |pmc=119894 |doi= |url=http://cvi.asm.org/cgi/pmidlookup?view=long&pmid=11777846}}</ref> a rod-shaped organism.<ref name=pmid11764080>{{Cite journal | last1 = Alkan | first1 = S. | last2 = Beals | first2 = TF. | last3 = Schnitzer | first3 = B. | title = Primary diagnosis of whipple disease manifesting as lymphadenopathy: use of polymerase chain reaction for detection of Tropheryma whippelii. | journal = Am J Clin Pathol | volume = 116 | issue = 6 | pages = 898-904 | month = Dec | year = 2001 | doi = 10.1309/7678-E2DW-HFJ5-QYUJ | PMID = 11764080 }}</ref> | ||
Epidemiology: | Epidemiology: | ||
| Line 46: | Line 46: | ||
Treatment: | Treatment: | ||
*Antibiotics - for months and months. | *Antibiotics - for months and months. | ||
==Gross== | |||
*Pale yellow or white spots.<ref>{{Cite journal | last1 = Salkic | first1 = NN. | last2 = Alibegovic | first2 = E. | last3 = Jovanovic | first3 = P. | title = Endoscopic appearance of duodenal mucosa in Whipple's disease. | journal = Gastrointest Endosc | volume = 77 | issue = 5 | pages = 822-3; discussion 823 | month = May | year = 2013 | doi = 10.1016/j.gie.2013.01.016 | PMID = 23490230 }}</ref> | |||
==Microscopic== | ==Microscopic== | ||
Features:<ref name=pmid15476147>{{cite journal | author=Bai J, Mazure R, Vazquez H, Niveloni S, Smecuol E, Pedreira S, Mauriño E | title=Whipple's disease | journal=Clin Gastroenterol Hepatol | volume=2 | issue=10 | pages=849?60 | year=2004 | pmid=15476147 | doi=10.1016/S1542-3565(04)00387-8}}</ref> | Features:<ref name=pmid15476147>{{cite journal | author=Bai J, Mazure R, Vazquez H, Niveloni S, Smecuol E, Pedreira S, Mauriño E | title=Whipple's disease | journal=Clin Gastroenterol Hepatol | volume=2 | issue=10 | pages=849?60 | year=2004 | pmid=15476147 | doi=10.1016/S1542-3565(04)00387-8}}</ref> | ||
* | *Rod-shaped microorganisms - typically found in macrophages. | ||
**Macrophages usually abundant - '''key feature''' that should raise Dx in DDx. | **Macrophages usually abundant - '''key feature''' that should raise Dx in DDx. | ||
**Organisms periodic acid-Schiff (PAS) positive. | **Organisms periodic acid-Schiff (PAS) positive. | ||
DDx: | DDx: | ||
*[[Mycobacterium avium complex]] (MAC). | *[[Mycobacterium avium complex]] (MAC) - not hole-y. | ||
*Crushed Brunner's glands - PAS-Alcian blue stain +ve (like Whipple's disease). | |||
===Images=== | ===Images=== | ||
<gallery> | <gallery> | ||
Image: | Image: Whipple disease - low mag.jpg | Low mag. | ||
Image: | Image: Whipple disease - intermed mag.jpg | Intermed. mag. | ||
Image: Whipple disease - high mag.jpg | High mag. | |||
Image: Whipple disease - very high mag.jpg | Very high mag. | |||
</gallery> | |||
<gallery> | |||
Image: Whipple disease -a- high mag.jpg | High mag. | |||
Image: Whipple disease -a- very high mag.jpg | Very high mag. | |||
</gallery> | |||
<gallery> | |||
Image:Whipple2.jpg | Whipple disease - poor quality - low mag. (WC) | Image:Whipple2.jpg | Whipple disease - poor quality - low mag. (WC) | ||
</gallery> | </gallery> | ||
==Stains== | ==Stains== | ||
*PAS +ve organisms. | *PAS +ve organisms. | ||
*[[AFB stain]] -ve -- to r/o [[MAI]]. | *[[AFB stain]] -ve -- to r/o [[MAI]]. | ||
===Images=== | |||
*[http://www.biomedcentral.com/content/figures/1472-6823-6-3-2-l.jpg Whipple disease - PAS stain (biomedcentral.com)]. | *[http://www.biomedcentral.com/content/figures/1472-6823-6-3-2-l.jpg Whipple disease - PAS stain (biomedcentral.com)]. | ||
*[https://www.flickr.com/photos/euthman/6881958781/ Whipple disease - PAS (flickr.com/euthman)]. | |||
==See also== | ==See also== | ||
*[[Duodenum]]. | *[[Duodenum]]. | ||
*[[Colorectal xanthomatous polyp]]. | |||
==References== | ==References== | ||
Latest revision as of 15:01, 30 May 2020
| Whipple's disease | |
|---|---|
| Diagnosis in short | |
 Whipple's disease. H&E stain. | |
|
| |
| LM | rod-shaped microorganisms - typically in macrophages; lamina propria macrophages usually abundant |
| LM DDx | mycobacterium avium complex |
| Stains | PAS +ve (microorganisms), AFB -ve |
| Site | duodenum |
|
| |
| Clinical history | usu. middle aged men |
| Signs | diarrhea |
| Prevalence | very rare |
| Prognosis | good |
| Treatment | antibiotics |
Whipple's disease is a rare infectious disease that is classically found in the duodenum.
General
Etiology:
Epidemiology:
- Very rare.
- Classically middle aged men.
Clinical
- Malabsorption (diarrhea), arthritis + others.
- Symptoms are non-specific.
Treatment:
- Antibiotics - for months and months.
Gross
- Pale yellow or white spots.[3]
Microscopic
Features:[4]
- Rod-shaped microorganisms - typically found in macrophages.
- Macrophages usually abundant - key feature that should raise Dx in DDx.
- Organisms periodic acid-Schiff (PAS) positive.
DDx:
- Mycobacterium avium complex (MAC) - not hole-y.
- Crushed Brunner's glands - PAS-Alcian blue stain +ve (like Whipple's disease).
Images
Low mag.
Intermed. mag.
High mag.
Very high mag.
High mag.
Very high mag.
Whipple disease - poor quality - low mag. (WC)
Stains
Images
See also
References
- ↑ Liang Z, La Scola B, Raoult D (January 2002). "Monoclonal antibodies to immunodominant epitope of Tropheryma whipplei". Clin. Diagn. Lab. Immunol. 9 (1): 156?9. PMC 119894. PMID 11777846. http://cvi.asm.org/cgi/pmidlookup?view=long&pmid=11777846.
- ↑ Alkan, S.; Beals, TF.; Schnitzer, B. (Dec 2001). "Primary diagnosis of whipple disease manifesting as lymphadenopathy: use of polymerase chain reaction for detection of Tropheryma whippelii.". Am J Clin Pathol 116 (6): 898-904. doi:10.1309/7678-E2DW-HFJ5-QYUJ. PMID 11764080.
- ↑ Salkic, NN.; Alibegovic, E.; Jovanovic, P. (May 2013). "Endoscopic appearance of duodenal mucosa in Whipple's disease.". Gastrointest Endosc 77 (5): 822-3; discussion 823. doi:10.1016/j.gie.2013.01.016. PMID 23490230.
- ↑ Bai J, Mazure R, Vazquez H, Niveloni S, Smecuol E, Pedreira S, Mauriño E (2004). "Whipple's disease". Clin Gastroenterol Hepatol 2 (10): 849?60. doi:10.1016/S1542-3565(04)00387-8. PMID 15476147.