© 2003 Fellowship of Postgraduate Medicine
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A diagnostic conundrum
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The diagnosis is Whipple’s disease. This is a rare multisystem disorder characterised by weight loss, diarrhoea, abdominal pain, arthralgia and lymphadenopathy, though presentation may be very variable. It is caused by a Gram positive, PAS positive bacillus called Tropheryma whippelii which was identified in 1992.1
It has been reported in all age groups, though it is commonest in middle aged white males. Whipple’s disease commonly involves the gastrointestinal tract causing a dilated thickened intestine with villous atrophy and malabsorption, resulting in anorexia, weight loss, abdominal pain, anaemia, hypoalbuminaemia and rarely, clotting disorders.
The heart and all its layers can be affected. Polyarthralgia is common though transient and episodic. Generalised hyperpigmentation can be found in up to 50% of patients. One of the striking features is mesenteric, abdominal, retroperitoneal, mediastinal, and peripheral lymphadenopathy which can often be mistaken for lymphoma, sarcoidosis, or other granulomatous disorders. Ten percent of patients have neurological
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- A diagnostic conundrum
- R C Rakshit and J D Mackay
Postgrad. Med. J. 2003 79: 540.[Extract] [Full Text] [PDF]
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