Related Experiment Videos
Whipple's Disease with Long-term Endoscopic Follow-up
Hiroaki Saito1,2, Junji Shiode1, Shogen Ohya1,3
1Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan.
Internal Medicine (Tokyo, Japan)
|February 14, 2018
Summary
Whipple's disease, a rare bacterial infection, can cause significant weight loss. Long-term antibiotic treatment, like trimethoprim-sulfamethoxazole, can lead to symptom resolution, even if diagnostic markers persist.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Whipple's disease is a rare, chronic, multisystemic bacterial infection caused by Tropheryma whipplei.
- It often affects the gastrointestinal tract, leading to malabsorption and weight loss.
- Diagnosis typically relies on characteristic endoscopic and histopathological findings.
Observation:
- A 72-year-old male presented with significant anorexia and a 15-kg unintentional weight loss over three years.
- Endoscopic examination of the duodenum revealed abnormal mucosa, described as yellow, shaggy, and interspersed with erythematous, eroded areas.
- Duodenal biopsy demonstrated massive infiltration of the lamina propria by periodic acid-Schiff-positive macrophages, confirming Whipple's disease.
Findings:
- The patient received initial treatment with intravenous ceftriaxone for four weeks, followed by oral trimethoprim-sulfamethoxazole.
- Clinical improvement was observed, with gradual weight regain and resolution of anorexia.
- While endoscopic findings improved with continuous trimethoprim-sulfamethoxazole, duodenal macrophage infiltration persisted, indicating a potential disconnect between clinical and histological resolution.
Implications:
- This case highlights the efficacy of prolonged antibiotic therapy, specifically trimethoprim-sulfamethoxazole, in managing Whipple's disease.
- It suggests that persistent histological findings of macrophage infiltration may not preclude long-term clinical remission.
- The findings underscore the importance of clinical monitoring and sustained treatment in achieving sustained symptom relief for patients with Whipple's disease.