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Whipple's disease: pathogenetic considerations.

K J Ho, W T Crowell, G A Herrera

    Southern Medical Journal
    |March 1, 1983
    PubMed
    Summary
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    Whipple's disease, a rare condition causing malabsorption and arthritis, can be diagnosed via duodenal biopsy. Antibiotic treatment effectively resolves symptoms, highlighting its importance in differential diagnosis.

    Area of Science:

    • Gastroenterology
    • Rheumatology
    • Infectious Diseases

    Background:

    • Whipple's disease is a rare systemic infection characterized by malabsorption and arthritis.
    • Diagnosis often involves invasive procedures and can be delayed due to its rarity.

    Observation:

    • A five-year presentation of malabsorption and nondeforming peripheral arthritis was investigated.
    • Diagnostic methods included duodenal mucosal biopsy with light and electron microscopy, and immunofluorescence.
    • Histologic examination revealed characteristic Whipple's bacilli and immune responses.

    Findings:

    • Definitive diagnosis was confirmed by duodenal biopsy showing characteristic histologic features and Whipple's bacilli.
    • Electron microscopy identified intracellular and extracellular bacilli, while immunofluorescence showed a specific immune cross-reactivity.

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  • Pathogenesis involves macrophages due to a lack of effective host immune response to the bacilli.

    • Implications:

    • Antibiotic therapy led to significant symptom improvement and weight restoration.
    • Whipple's disease should be considered in the differential diagnosis for patients presenting with malabsorption and peripheral arthritis.
    • Early diagnosis and treatment are crucial for managing Whipple's disease effectively.