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[Changes in the duodenal mucosa in Whipple's disease]
P N Sementsov1, S V Petrukhin, L I Butorova
1Pathomorphological Department, Central Pathology Laboratory of the Main Military Medical Division of the Defence Ministry, Moscow.
Abstract:
A case of Whipple's disease is described in a male patient of 43 who has been previously examined in different hospitals for six years. The diagnosis was established after surgery and histological examination of the duodenum biopsy. Infiltration of the tunica propria of the duodenum with PAS-positive macrophages was observed. Therapy with rondomycin in combination with GUMET-P produced a response but the recurrence took place after therapy. A new operation was followed by peritonitis and pneumonia which terminated in the patient's death.
Insights
Whipple's disease, a rare gastrointestinal disorder, was diagnosed in a 43-year-old male after a six-year diagnostic odyssey. Despite initial treatment response, the patient experienced recurrence and ultimately succumbed to complications.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pathology
Background:
- Whipple's disease is a rare, chronic, systemic infectious disease.
- Characterized by bacterial infection, typically Tropheryma whipplei.
- Often presents with gastrointestinal and systemic symptoms, leading to diagnostic challenges.
Observation:
- A 43-year-old male patient presented with a six-year history of undiagnosed symptoms.
- Diagnosis was confirmed via duodenal biopsy showing PAS-positive macrophages in the tunica propria.
- The patient exhibited characteristic histopathological findings of Whipple's disease.
Findings:
- Initial therapy with rondomycin and GUMET-P showed a partial response.
- The patient experienced a relapse of Whipple's disease after the initial treatment course.
- Histological confirmation of Tropheryma whipplei infiltration was key to diagnosis.
Implications:
- Highlights the diagnostic challenges associated with Whipple's disease, often requiring years for confirmation.
- Underscores the potential for recurrence even after apparent treatment response.
- Emphasizes the critical role of histopathological examination in diagnosing rare conditions like Whipple's disease.