Whipple's Disease

Exam Cram

• Caused by organism Tropheryma Whipplei

• Presentation: malabsorption and arthralgia

• Ix: small bowel inflammtion- PAS +ve biopsy

• Management: ceftriaxone 2w + sulfamethoxazole 2 years

Outline

Background 

Whipple's is caused by an infection of Tropheryma Whipplei. The small bowel is responsible for nutritional absorption. In Whipple's the organism caused malabsorption by small bowel inflammation as well as arthalgia. 

Biospy of the small bowel reveals 

Assessment

History:

• Malabsorption: Diarrhoea, weight loss

• Arthralgia

Examination:

• Arthralgia

Investigations

• Small bowel biopsy: PAS (periodic acid Schiff)

  • Also:  positive macrophages, villous atrophy

• Anaemia

Diagnosis

Diagnostic criteria: SI biopsy GAS +ve, Tropheryma Whipplei 

Differentials

• Malabsorption - coeliac, Crohn's, gastroeneteritis (e.g. giardia), parasites, 

• Seronegative arthropaties: PEAR- psoriatic, enteric, ankylosing spondylitis, reactive arthritis

• PAS +ve biopsy in liver = alpha trypsin deficiency

Management

1.  Ceftriaxone 2-4 weeks, then sulfamethoxazole 1-2 years

Resources & References

Page written in 2024.