Atypical Whipple's disease with special endoscopic manifestations: A case report
Whipple's disease is a rare systemic infection caused by . Most patients present with nonspecific symptoms, and routine laboratory and imaging examination results also lack specificity. The diagnosis often relies on invasive manipulation, pathological examination, and molecular techniques. Thes...
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Published in | World journal of clinical cases Vol. 10; no. 35; pp. 13044 - 13051 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Baishideng Publishing Group Inc
16.12.2022
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Abstract | Whipple's disease is a rare systemic infection caused by
. Most patients present with nonspecific symptoms, and routine laboratory and imaging examination results also lack specificity. The diagnosis often relies on invasive manipulation, pathological examination, and molecular techniques. These difficulties in diagnosing Whipple's disease often result in misdiagnosis and inappropriate treatments.
This paper reports on the case of a 58-year-old male patient who complained of fatigue and decreased exercise capacity. The results of routine blood tests indicated hypochromic microcytic anemia. Results of gastroscopy and capsule endoscopy showed multiple polypoid bulges distributed in the duodenal and proximal jejunum. A diagnosis of small intestinal adenomatosis was initially considered; hence, the Whipple procedure, a pylorus-preserving pancreaticoduodenectomy, was performed. Pathological manifestations showed many periodic acid-Schiff-positive macrophages aggregated in the intestinal mucosa of the duodenum, upper jejunum, and surrounding lymph nodes. Based on comprehensive analysis of symptoms, laboratory findings, and pathological manifestations, the patient was finally diagnosed with Whipple's disease. After receiving 1 mo of antibiotic treatment, the fatigue and anemia were significantly improved.
This case presented with atypical gastrointestinal manifestations and small intestinal polypoid bulges, which provided new insight on the diagnosis of Whipple's disease. |
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AbstractList | Whipple's disease is a rare systemic infection caused by
. Most patients present with nonspecific symptoms, and routine laboratory and imaging examination results also lack specificity. The diagnosis often relies on invasive manipulation, pathological examination, and molecular techniques. These difficulties in diagnosing Whipple's disease often result in misdiagnosis and inappropriate treatments.
This paper reports on the case of a 58-year-old male patient who complained of fatigue and decreased exercise capacity. The results of routine blood tests indicated hypochromic microcytic anemia. Results of gastroscopy and capsule endoscopy showed multiple polypoid bulges distributed in the duodenal and proximal jejunum. A diagnosis of small intestinal adenomatosis was initially considered; hence, the Whipple procedure, a pylorus-preserving pancreaticoduodenectomy, was performed. Pathological manifestations showed many periodic acid-Schiff-positive macrophages aggregated in the intestinal mucosa of the duodenum, upper jejunum, and surrounding lymph nodes. Based on comprehensive analysis of symptoms, laboratory findings, and pathological manifestations, the patient was finally diagnosed with Whipple's disease. After receiving 1 mo of antibiotic treatment, the fatigue and anemia were significantly improved.
This case presented with atypical gastrointestinal manifestations and small intestinal polypoid bulges, which provided new insight on the diagnosis of Whipple's disease. |
Author | Zhou, Yuan-Chen Liu, Hong-Yan Yao, Shu-Kun Yin, Teng-Fei Zhang, Qing-Rui Chen, Shuo Si, Shuang Du, Shi-Yu Xie, Chu-Xi |
Author_xml | – sequence: 1 givenname: Shuo surname: Chen fullname: Chen, Shuo organization: Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China – sequence: 2 givenname: Yuan-Chen surname: Zhou fullname: Zhou, Yuan-Chen organization: Peking University China-Japan Friendship School of Clinical Medicine, Peking University, Beijing 100029, China – sequence: 3 givenname: Shuang surname: Si fullname: Si, Shuang organization: Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China – sequence: 4 givenname: Hong-Yan surname: Liu fullname: Liu, Hong-Yan organization: Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, China – sequence: 5 givenname: Qing-Rui surname: Zhang fullname: Zhang, Qing-Rui organization: Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China – sequence: 6 givenname: Teng-Fei surname: Yin fullname: Yin, Teng-Fei organization: Peking University China-Japan Friendship School of Clinical Medicine, Peking University, Beijing 100029, China – sequence: 7 givenname: Chu-Xi surname: Xie fullname: Xie, Chu-Xi organization: Graduate School, Beijing University of Chinese Medicine, Beijing 100029, China – sequence: 8 givenname: Shu-Kun surname: Yao fullname: Yao, Shu-Kun organization: Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China – sequence: 9 givenname: Shi-Yu surname: Du fullname: Du, Shi-Yu email: shiyudu1975@163.com organization: Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China. shiyudu1975@163.com |
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Copyright | The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. 2022 |
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Keywords | Intestinal polyposis Case report Whipple’s disease Whipple operation PAS staining Endoscopy Tropheryma whipplei |
Language | English |
License | The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0 |
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Notes | Supported by The China-Japan Friendship Hospital Foundation, No. 2019-1-QN-2. Author contributions: Chen S, Zhou YC, Zhang QR, and Yin TF wrote the main manuscript text under the guidance of Du SY and Yao SK; Si S, Liu HY, and Xie CX prepared the figures; all authors have read and approved the final manuscript. Corresponding author: Shi-Yu Du, MD, PhD, Chief Physician, Professor, Department of Gastroenterology, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing 100029, China. shiyudu1975@163.com |
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Title | Atypical Whipple's disease with special endoscopic manifestations: A case report |
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