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Atypical Whipple's disease.

Anurag Mehta¹, Nikhil Patkar, S Duhan

¹Department of Pathology, Armed Forces Medical College, Pune-411 010, India.

Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology

|March 22, 2005

Summary

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This case highlights a rare presentation of Whipple's disease, initially mimicking celiac disease. Patient-assisted diagnosis through duodenal biopsy confirmed the condition, emphasizing atypical clinical manifestations.

Area of Science:

Gastroenterology
Infectious Diseases
Histopathology

Background:

Whipple's disease is a rare systemic bacterial infection caused by Tropheryma whipplei.
It typically affects the small intestine but can involve multiple organ systems.
Classic symptoms include arthralgia, abdominal pain, diarrhea, and weight loss, but presentations can be highly variable.

Observation:

A patient presented with a dermatitis herpetiformis-like rash, constipation, and intermittent diarrhea.
Initial clinical suspicion pointed towards celiac disease due to overlapping gastrointestinal symptoms.
The patient's own input was crucial in guiding the diagnostic process.

Findings:

Duodenal biopsy was performed based on the suspicion of celiac disease.

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Histological examination of the biopsy revealed characteristic features of Whipple's disease.

Electron microscopy confirmed the presence of bacilli within macrophages, consistent with Tropheryma whipplei infection.

Implications:

This case underscores the importance of considering Whipple's disease in patients with unexplained gastrointestinal and dermatological symptoms.
Atypical presentations can delay diagnosis, necessitating a high index of suspicion.
Patient collaboration can be instrumental in navigating complex diagnostic pathways for rare diseases.