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[Whipple's disease--a challenging diagnosis]
Ana C Carneiro1, Palmira Lima, Isabel P Barbosa
1Serviço de Medicina A, Hospital S. João, Porto.
Acta Medica Portuguesa
|October 4, 2005
Summary
Whipple's Disease, a rare multisystemic infection by Tropheryma whippelii, often presents with varied symptoms leading to delayed diagnosis. Early detection and trimethoprim-sulfamethoxazole treatment can effectively manage this actinobacteria infection.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Microbiology
Background:
- Whipple's Disease is a rare, chronic, multisystemic infectious disease caused by the Gram-positive bacillus Tropheryma whippelii.
- Delayed diagnosis is common due to the disease's rarity and diverse clinical manifestations.
Observation:
- A 50-year-old male presented with weight loss, abdominal pain, ascites, diarrhea, and a four-year history of arthralgias.
- Diagnosis was confirmed via laparotomy, revealing mesenteric adenopathies and liver biopsy with foamy macrophages containing PAS-positive, diastase-resistant material.
Findings:
- Tropheryma whippelii was identified in biopsy specimens using electron microscopy.
- Treatment with trimethoprim-sulfamethoxazole resulted in symptom resolution and normalization of biological values.
Implications:
- This case highlights the importance of considering Whipple's Disease in patients with unexplained gastrointestinal and systemic symptoms.
- Effective antibiotic therapy, such as trimethoprim-sulfamethoxazole, can lead to favorable outcomes.
- Further research into diagnostic modalities and long-term follow-up is warranted.