Whipple’s disease is a rare infection caused by the gram positive bacterium tropheryma whipplei . It may involve any organ system but most frequently affects the GI tract.
Whipple’s disease tends to present with:
- Weight loss
- Diarrhoea
- Fever
- Arthralgia
- Abdominal pain
It also causes malabsoption so patients may present with clinical manifestations of this – for example, with anaemia due to B12 deficiency.
Up to a third of patients will have cardiac involvement, classically culture-negative endocarditis.
Possible clinical signs include
- Skin hyperpigmentation
- Lymphadenopathy
Whipple’s disease is commonest in Caucasian males (8:1)
Diagnosis is by
- Histology – foamy macrophages filled with periodic acid-Schiff (PAS) positive particles
- PCR
Treatment is 2 weeks IV ceftriaxone then 1 year of oral co-trimoxazole (=trimethoprim/sulfamethozaxole)
Small print gem: the original name for Whipple's disease was "intestinal lipodystrophy"
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