Whipple's disease

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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:

  • Infection - caused by Tropheryma whipplei[1] a rod-shaped organisms.[2]

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:

Images

Stains

Images

See also

References

  1. 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.
  2. 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.
  3. 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.
  4. 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.