Whipple disease diagnosed by enteroscopy: first case report in Colombia of an underdiagnosed disease and literature review

BMC Gastroenterology

卷:20

Fernando Sierra-Arango¹  Margarita Rey R.²  Luis Alejandro Orozco³  Rocio López⁴  José De la Hoz-Valle⁵  Erika D. Pérez-Riveros⁵  Katherine Marrugo⁶ 

[1] Gastroenterology and Hepatology Department, Digestive Endoscopy Section, Fundación Santa Fe de Bogotá and Universidad de los Andes Medical School;

[2] Gastroenterology and Hepatology Department, Digestive Endoscopy Section, Fundación Santa Fe de Bogotá;

[3] Global Medical Center;

[4] Pathology Department, Fundación Santa Fe de Bogotá;

[5] Subdirección de Estudios Clínicos y Epidemiología Clínica (SECEC), Fundación Santa Fe de Bogotá;

[6] Universidad del Rosario;

关键词: Whipple disease;    Tropheryma;    Capsule endoscopes;    Periodic acid-Schiff reaction;    Antibiotics;    Case report;   

DOI  :  10.1186/s12876-020-01302-2

来源: DOAJ

【 摘 要 】

Abstract Background Whipple’s disease is a rare systemic disease caused by a gram-positive bacillus called Tropheryma whipplei. First described in 1907 as an intestinal lipodystrophy with histological finding of vacuoles in the macrophages of the intestinal mucous. Usually the symptoms are localized according to the compromised organ. The differential diagnosis is wide. It can be fatal without proper treatment. Recurrence can occur in up to 33% of the cases and usually compromises the neurological system. Case presentation This article reports the case of a 46-year-old female patient with a history of a 6-month hypochromic microcytic anemia of unknown cause. She consulted for a 6-months oppressive abdominal pain located in the mesogastrium as well as abdominal distention associated with nausea and liquid stools; in addition, she had an 8-month small and medium joint pain, without edema or erythema. Physical examination without relevant findings. Multiple esophagogastroduodenoscopies with normal gastric and duodenal biopsies findings and a normal colonoscopy were performed. Endoscope capsule showed red spots in the duodenum and ulcerations in the jejunum and proximal ileum covered by fibrin; histological report showed macrophages with positive periodic acid-schiff reaction staining (PAS staining), disgnosing Whipple’s disease. Antibiotics were initiated. The patient is currently in the second phase of treatment without gastrointestinal and joint symptoms. Conclusion This is the first case reported in Colombia. It is a rare entity and difficult to diagnose reason why it is important to continue with clinical investigations to give more clarity about the onset and appropriate diagnose to avoid the delay in treatment of this entity.

【 授权许可】

Unknown