Gastroenterology

Answer 4 Whipple’s disease. Whipple’s disease is caused by infection with Tropheryma whippelii (a gram-negative bacillus), and it often manifests with multiorgan involvement. Adenopathy (from lymphatic involvement), joint pains (from arthritis), and fevers are often prominent symptoms. Patients can also develop pulmonary, cardiac, or neurologic manifestations; they may present with chronic cough, congestive heart failure, or a variety of neurologic complaints ranging from cranial nerve abnormalities (eg, deafness, diplopia) to overt dementia. Anemia with associated flow murmurs are also common. The finding of periodic acid-Schiff-positive macrophages in the lamina propria on small bowel biopsy is definitive for a diagnosis of Whipple’s disease. Click here to return to the questions

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