Clinical and Experimental Medical Journal
Volume/Issue:
Volume 4: Issue 1
Whipple's disease: Do we think of it enough?
Authors: Tünde Fischer 1 , 3 , Márta Tiboly 1 , Péter Tóth 1 , Mária Szenes 1 , Zoltán VÖlgyi 1 , Otília Bali 2 , and Beáta Gasztonyi 1
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  • 1 Department of Medicine, Hospital of Zala County, Zalaegerszeg, Hungary
  • 2 Department of Pathology, Hospital of Zala County, Zalaegerszeg, Hungary
  • 3 Zrínyi M. str. 1, H-8900, Zalaegerszeg, Hungary
DOI:
https://doi.org/10.1556/CEMED.4.2010.28668
Page Count:
175–185
Publication Date:
01 Mar 2010
Online Publication Date:
01 Mar 2010
Article Category:
Research Article
Restricted access

Abstract

Whipple's disease is a chronic, systemic, relapsing bacterial illness, which always has a fatal outcome without treatment. It represents a significant diagnostic challenge for both clinicians and pathologists. In 80% of cases, the disease affects middle-aged white men belonging to the Caucasian race. Case report: The authors present three cases and review the aetiology, clinical features, presumed pathomechanism and the possibilities of treatment. Conclusion: Several immunologic mechanisms underlying Whipple's disease have emerged, but their primary or secondary nature has not yet been elucidated. First of all, this is a gastrointestinal disease; however, extraintestinal symptoms may often precede final diagnosis by several years. The histological hallmark for the diagnosis is the presence of numerous macrophages in the duodenal mucosa showing periodic acid — Schiff (PAS)-positive inclusions as well as polymerase chain reaction. The choice of antibiotics and the duration of therapy are empirical, but in most cases, there is an immediate response to the treatment. Relapses are common, particularly in patients with central nervous system involvement.

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Cover Clinical and Experimental Medical Journal
Clinical and Experimental Medical Journal
Print ISSN:
2060-6249
Online ISSN:
2060-968X
Keywords:
Whipple's disease; malabsorption syndromes; lymph node enlargement; positive PAS stain; AIDS, acquired immunodeficiency syndrome; CNS, central nervous system; CRP, C-reactive protein; CT, computer tomography; ESR, erythrocyte sedimentation rate; IFN, interferon; IL, interleukin; ITP, idiopathic thrombocytopenic purpura; PAS, periodic acid — Schiff; PCR, polymerase chain reaction; pro-BNP, N-terminal prohormone brain natriuretic peptide; Plt, platelet; TNF, tumour necrosis factor; US, ultrasound

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