Answers Paper 4
Anna Kowalewski, Priya Jeevananthan in Get Ahead! Basic Sciences, 2017
Whipple disease is a rare systemic infection caused by the bacterium Tropheryma whipplei. It may aect any part of the body but is most commonly considered a gastrointestinal disease. Biopsy will reveal periodic acid-Schi (PAS)-positive macrophage inclusions. Treatment is with antibiotics for up to 2 years, and this may not be successful and result in relapse. Cryptosporidiosis is a parasitic disease which will cause selflimiting diarrhoea in those not immunocompromised. However, in the immunocompromised a more severe form may manifest.
DUODENUM
C. Daniel Johnson, Grant D. Schmit in Mayo Clinic Gastrointestinal Imaging Review, 2005
Discussion The most frequent cause of thickened duodenal folds is peptic ulcer disease. The folds may be enlarged as a result of edema, or Brunner gland hyperplasia (case 3.34) may simulate fold thickening. Usually, multiple enlarged, discrete nodules that form a cobblestone appearance are present in patients with Brunner gland hyperplasia. Most cases of duodenitis are caused by Helicobacter pylori infection. Treatment is with antibiotics and acid blockers. Patients with Crohn disease (cases 3.15, 3.16, and 3.17), giardiasis (case 4.48), sprue (case 3.18), Whipple disease (case 4.49), and lymphoma (case 4.55) also can present with thickened duodenal folds.
Ocular Whipple Disease: Report of Three Cases
Published in Ocular Immunology and Inflammation, 2019
Ilaria Testi, Maria Sofia Tognon, Vishali Gupta
Purpose: To emphasize the different manifestations of ocular involvement in Whipple disease with challenge in establishing the diagnosis as clinical, laboratory, and histological features could mimic other uveitis entities. Methods: Case reports of three patients. Results: The first patient was an African male suffering from a chronic bilateral keratoconjunctitivitis that was initially misdiagnosed as a chronic allergic conjunctivitis. The second patient was an Italian female who presented with bilateral vitritis, whereas the third patient was an Italian male suffering from a chronic bilateral panuveitis. The diagnosis of ocular Whipple in the first and third case was made by a positive T. whipplei PCR from the ocular specimen, and the second patient had detection of T. whipplei from extraocular sites. Conclusions: Whipple disease can have protean manifestations in the eye including an isolated ocular surface involvement manifested as keratitis.
An unusual cause of pancytopenia: Whipple's disease
Published in Journal of Community Hospital Internal Medicine Perspectives, 2014
Nay T. Tun, Shwetanshu Shukla, Jaykrishnan Krishnakurup, Binu Pappachen, Mahesh Krishnamurthy, Hayman Salib
Whipple's disease is a systemic infectious disease caused by the bacteria Tropheryma whipplei. The most common clinical manifestations of Whipple's disease are weight loss (92%), hypoalbuminemia and steatorrhea (91%, respectively), diarrhea (72%), arthralgia (67%), and abdominal pain (55%). Neurological signs and symptoms from dementia to oculomasticatory myorhythmia or oculofacioskeletal myorhythmia (pathognomonic of Whipple's disease), lymphadenopathy, and fatigue can also be present. Pancytopenia is a rare and less recognized clinical feature in Whipple's disease patients. We are describing a case where a middle-aged Caucasian male diagnosed with Whipple's disease was found to have pancytopenia. Etiology of pancytopenia is postulated to be due to the invasion of bone marrow by T. whipplei. It is important to recognize that bone marrow involvement by the Whipple bacillus is not uncommon. In the presence of lymphadenopathy and pancytopenia, clinicians should think of Whipple's disease as a differential diagnosis apart from lymphoma or other non-specific granulomatous reticuloendothelial disorders.
A patient with cerebral Whipple's disease and a stroke-like syndrome
Published in Scandinavian Journal of Gastroenterology, 2005
Giuseppe Famularo, Giovanni Minisola, Claudio De Simone
The central nervous system (CNS) may be affected in up to 50% of patients with Whipple's disease and this can occur even with little or no gastrointestinal involvement. We describe a 63-year-old patient in whom CNS involvement with Whipple's disease had the clinical and imaging features of a brain infarction. Treatment with aspirin and ceftriaxone followed by trimethoprim-sulfamethoxazole resulted in a good neurological recovery and complete remission of the malabsorption syndrome. Cerebral Whipple's disease resembling a stroke syndrome has so far been reported in only two other patients and in both cases it represented the first presentation of the disease. Arterial or arteriolar fibrosis, thrombosis and thickening associated with the inflammation of adjacent brain parenchyma and leptomeninges, and cerebral vasculitis caused by the hematogenous spread of Tropheryma whippelii to the brain may all be important triggers of brain infarction in patients with Whipple's disease. Our case report highlights the important point that cerebral Whipple's disease with the features of a stroke syndrome, if recognized early and treated aggressively with antibiotics, could have a favorable course with no long-term disability sequelae.
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