An Atypical Presentation of Whipple Disease in an African Immigrant
AAPA ePoster library. Cieply A. 05/17/17; 180522; 161
Alex Cieply
Alex Cieply
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Abstract
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Introduction Whipple disease is a systemic infection caused by Tropheryma whipplei, a Gram-positive bacillus bacteria. Clinically, presentation includes non-specific constitutional, gastrointestinal and musculoskeletal manifestations. The illness is estimated to infect upwards of 4% of the general population and 12% of those at high-risk (sewage workers, agriculturalists and the homeless). The diagnostic approach includes thorough history and physical examination, evaluation of suspicious imaging findings via biopsy and analysis with histological stains and polymerase chain reaction. Case Description A 39 year old African gentleman presented to the emergency department with a one week history of intractable abdominal pain, constipation and anorexia. Careful history revealed that he had emigrated from the West African coast approximately 20 years prior. Since immigrating to the United States, he endorsed overall good health before becoming ill the week prior to his presentation. He described a one year history of unintentional weight loss (20 pounds) with associated low back pain. Physical exam revealed a well-built, healthy-appearing patient with only mild epigastric tenderness to palpation. Initial studies demonstrated a low-grade fever (Tmax = 99.8 °F), mild leukocytosis (11,700/mm3), microcytic anemia (hemoglobin, 11.9 g/dL; mean corpuscular volume, 72 fL) and extensive mesenteric lymphadenopathy on imaging. Given the intractable abdominal pain and inability to tolerate oral intake, he was admitted to the hospital and underwent further evaluation including esophagogastroduodenoscopy (EGD) and mesenteric lymph node fine needle aspiration. Biopsy of the lymph nodes noted a positive periodic acid-Schiff (PAS) stain and negative acid-fast bacilli (AFB) stain. Gastric biopsy was notable for acute-on-chronic gastritis. The clinical presentation coupled with the biopsy results were consistent with infection by both T. whipplei and Helicobacter pylori as determined by immunohistochemical findings. Outcome The patient had an uncomplicated three-day hospital course. Upon diagnosis, he was treated with two weeks of daily intravenous (IV) ceftriaxone (2 g) via a peripherally-inserted central catheter, followed by one year of oral double strength trimethoprim-sulfamethoxazole (160/800 mg) for the T. whipplei infection. Following the completion of intravenous antibiotic treatment, he was also treated ...
Introduction Whipple disease is a systemic infection caused by Tropheryma whipplei, a Gram-positive bacillus bacteria. Clinically, presentation includes non-specific constitutional, gastrointestinal and musculoskeletal manifestations. The illness is estimated to infect upwards of 4% of the general population and 12% of those at high-risk (sewage workers, agriculturalists and the homeless). The diagnostic approach includes thorough history and physical examination, evaluation of suspicious imaging findings via biopsy and analysis with histological stains and polymerase chain reaction. Case Description A 39 year old African gentleman presented to the emergency department with a one week history of intractable abdominal pain, constipation and anorexia. Careful history revealed that he had emigrated from the West African coast approximately 20 years prior. Since immigrating to the United States, he endorsed overall good health before becoming ill the week prior to his presentation. He described a one year history of unintentional weight loss (20 pounds) with associated low back pain. Physical exam revealed a well-built, healthy-appearing patient with only mild epigastric tenderness to palpation. Initial studies demonstrated a low-grade fever (Tmax = 99.8 °F), mild leukocytosis (11,700/mm3), microcytic anemia (hemoglobin, 11.9 g/dL; mean corpuscular volume, 72 fL) and extensive mesenteric lymphadenopathy on imaging. Given the intractable abdominal pain and inability to tolerate oral intake, he was admitted to the hospital and underwent further evaluation including esophagogastroduodenoscopy (EGD) and mesenteric lymph node fine needle aspiration. Biopsy of the lymph nodes noted a positive periodic acid-Schiff (PAS) stain and negative acid-fast bacilli (AFB) stain. Gastric biopsy was notable for acute-on-chronic gastritis. The clinical presentation coupled with the biopsy results were consistent with infection by both T. whipplei and Helicobacter pylori as determined by immunohistochemical findings. Outcome The patient had an uncomplicated three-day hospital course. Upon diagnosis, he was treated with two weeks of daily intravenous (IV) ceftriaxone (2 g) via a peripherally-inserted central catheter, followed by one year of oral double strength trimethoprim-sulfamethoxazole (160/800 mg) for the T. whipplei infection. Following the completion of intravenous antibiotic treatment, he was also treated ...
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