Whipple disease
- Tropheryma whipplei in macrophages in bowel mucosa
- Lymphatic obstruction→ fat malabsorption, protein losing enteropathy
C/F
- Diarrhea, steatorrhea, weight loss
- Ascites
- Low grade fever
- Large joint arthritis
Investigation:
| Investigation | Finding |
Small bowel biopsy with
|
|
Management:
- IV ceftriaxone 2 gm/day for 2 weeks followed by oral cotrimoxazole for at least 1 year
Follow up:
- Symptoms resolves quickly
- Biopsy changes revert to normal within few weeks
Long term follow up:
- Relapse may occur
- Relapse- same treatment / doxycycline and hydroxychloroquine