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Case Reports
. 2018 Jun 15;57(12):1707-1713.
doi: 10.2169/internalmedicine.9631-17. Epub 2018 Feb 9.

Whipple's Disease with Long-term Endoscopic Follow-up

Hiroaki Saito  1   2 , Junji Shiode  1 , Shogen Ohya  1   3 , Atsushi Yao  4 , Shunsuke Saito  1 , Masakuni Fujii  1 , Mamoru Itoh  1 , Shuhei Ishiyama  1 , Akiko Fujiwara  1 , Junichiro Nasu  1 , Masao Yoshioka  1 , Kazuhide Yamamoto  1
Affiliations
Case Reports

Whipple's Disease with Long-term Endoscopic Follow-up

Hiroaki Saito et al. Intern Med. .

Abstract

A 72-year-old man presented with anorexia and 15-kg weight loss over 3 years. Endoscopy revealed yellow, shaggy mucosa alternating with erythematous, eroded mucosa in the duodenum. Biopsy specimens showed massive infiltration of periodic acid-Schiff-positive macrophages in the lamina propria, consistent with Whipple's disease. The patient was treated with intravenous ceftriaxone for four weeks, followed by oral trimethoprim-sulfamethoxazole. His condition improved, and he gradually gained weight. Although the endoscopic findings improved with continuous trimethoprim-sulfamethoxazole administration, macrophage infiltration of the duodenal mucosa persisted. However, the patient has been symptom-free for eight years.

Keywords: Tropheryma whipplei; Whipple's disease; endoscopy; macrophage.

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Figures

Figure 1.
Figure 1.
Upper gastrointestinal endoscopy on readmission. Yellow, shaggy mucosa alternating with erythematous, eroded mucosa in the duodenum.
Figure 2.
Figure 2.
Histopathologic findings. (a) (b) Hematoxylin and Eosin staining [(a) ×40, (b) ×400]. Foamy macrophages are present in the epithelial villi of the duodenal mucosa (arrow). (c) Periodic acid-Schiff (PAS) staining (×400). Numerous PAS-positive macrophages are observed infiltrating the lamina propria of the duodenum. (d) Electron micrograph of the duodenal mucosa (×20,000) showing numerous rod-shaped bacilli with distinctive trilaminar cell walls characteristic of Tropheryma whipplei.
Figure 3.
Figure 3.
Clinical course after first admission. CTRX: ceftriaxone, PSL: prednisolone, TMP-SMX: trimethoprim-sulfamethoxazole
Figure 4.
Figure 4.
Upper gastrointestinal endoscopy on follow-up. Changes in the duodenal mucosa were improved in the early stage of treatment and never recurred. CTRX: ceftriaxone
Figure 5.
Figure 5.
Histopathologic findings at the 8-year follow-up. (a) Microscopy of the duodenal mucosa with Hematoxylin and Eosin staining (×100). Numerous foamy macrophages are noted. (b) Periodic acid-Schiff (PAS) staining (×100). Numerous PAS-positive macrophages are observed.
See this image and copyright information in PMC

References

    1. Fenollar F, Puéchal X, Raoult D. Whipple's disease. N Engl J Med 356: 55-66, 2007. - PubMed
    1. Puéchal X. Whipple disease and arthritis. Curr Opin Rheumatol 13: 74-79, 2001. - PubMed
    1. Enzinger FM, Helwig EB. Whipple's disease: a review of the literature and report fifteen patients. Virchows Arch Pathol Anat Physiol Klin Med 336: 238-269, 1963.
    1. Naramoto J, Tamechika Y, Niizeki H, et al. . A case of Whipple disease with non-specific multiple ulcer of the intestine. I to Cho (Stomach and Intestine) 11: 227-231, 1976. (in Japanese, Abstract in English).
    1. Tsuru T, Hamada T, Honda M, et al. . An autopsy case of Whipple disease. Saishin Igaku 34: 1993-1997, 1979. (in Japanese).

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