gastrointestinal disorders
Whipple Disease
Diagnosis of Whipple Disease
Endoscopy with small-bowel biopsy The diagnosis of Whipple disease may be missed in patients without prominent gastrointestinal symptoms. Whipple disease should be suspected in middle-aged White men who have arthritis and abdominal pain, diarrhea, weight loss, or other symptoms of malabsorption. Such patients should have upper endoscopy with small-bowel biopsy; the intestinal lesions are specific and diagnostic. The most severe and consistent changes are in the proximal small bowel. Light microscopy shows periodic acid-Schiff–positive macrophages that distort the villus architecture. Gram-positive, acid fast–negative bacilli (T. whipplei) are seen in the lamina propria and in the macrophages. IfT. whippleiare not seen but Whipple disease is still clinically suspected, polymerase chain reaction testing and immunohistochemistry should be done. Whipple disease should be differentiated from intestinal infection withMycobacterium avium-intracellulare(MAI), which has similar histologic findings. However, MAI stains positive with acid fast. 