Sara Samad, DO1, Mohammad Choudhry, MD1, Meron Debesai, MD1, Chantelle Begian, MD2, John Trillo, MD1 1Coney Island Hospital, Brooklyn, NY; 2Coney island Hospital, Brooklyn, NY
Introduction: Whipple’s disease (WD) is a rare ubiquitous disease with an annual incidence of 1/1,000,000. Since 1980, there have been 35 cases per year. The bacterium, Tropheryma whipplei (TW) is detectable in the saliva and feces of 35% of healthy individuals and is rarely found in intestinal mucosa without histopathology evidence.
Case Description/Methods: 41 yo Mexican male with PMHX of anemia presented with failure to thrive, oral thrush and a 20-pd unintentional weight loss over 1 month. Vitals: BP: 98/63mmhg. PE: ill and cachectic appearance, non-tender abdomen and brown stool. Labs: hemoglobin 7.7 g/dl. CT for suspected lymphoma showed retroperitoneal lymphadenopathy. Upper endoscopy (EGD) with biopsy: small intestinal and third portion of duodenum mucosa with fat vacuoles and distended macrophages containing PAS positive diastase resistant granules (figure1). He was diagnosed with WD and started on ceftriaxone 2g IV daily for 2 weeks with Bactrim DS one tablet twice daily for one year. He admitted to working with livestock. Schistosoma, HIV, QuantiFERON, hepatitis profile lumbar puncture (LP) and echocardiogram (TTE) were inconclusive. Symptoms improved and he was discharged on antibiotic therapy for 1 year.
Discussion: It’s imperative to suspect WD as it can be fatal if not managed timely. With a predilection to Caucasian men, a genetic predisposition is suggested. Our pt, being Mexican Native, was not typical. Recent literature hypothesizes immunocompromised predisposition to WD, having found WD pts with low CD4/CD8 ratio that normalize after treatment. Although he was HIV negative, he had oral thrush and a sub-clinical immune suppressive phenomenon cannot be excluded. Pts can present with a tetrad of symptoms: arthralgia, abdominal pain, weight loss and diarrhea. Arthritis, the most frequent initial symptom, precedes GI symptoms by years. Once manifested, the course rapidly progresses. Endocarditis and CNS involvement are major complications of WD, needing aggressive therapy.
Occupational and environmental exposures such as animal feces and soil are high risk. Our pt worked with livestock, was exposed to their excrement, fertilizing agents and human feces from cleaning restrooms of which TW has been reported to be found. His presentation of anemia, his exposure, and biopsy finding of TW was pathognomonic for WD. Echo and LP were negative for organ involvement. We present this case to inform of this rare disease, its findings, as it’s important to keep in mind as it can be detrimental.
Figure: Figure 1: Numerous PAS+ diastase resistant granules on biopsy
Disclosures: Sara Samad indicated no relevant financial relationships. Mohammad Choudhry indicated no relevant financial relationships. Meron Debesai indicated no relevant financial relationships. Chantelle Begian indicated no relevant financial relationships. John Trillo indicated no relevant financial relationships.
Sara Samad, DO1, Mohammad Choudhry, MD1, Meron Debesai, MD1, Chantelle Begian, MD2, John Trillo, MD1. P3020 - A Case of Whipples Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
