Whipple's disease differential diagnosis: Difference between revisions

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==Differentiating Whipple's disease from other Diseases==
==Differentiating Whipple's disease from other Diseases==
Whipple's disease must be differentiated from other diseases that cause [[malabsorption]], joins involvement, and neurologic symptoms, such as diseases that causes [[chronic diarrhea]], [[Infection|infections]], and [[Connective tissue disease|connective tissue diseases]].
Whipple's disease must be differentiated from other diseases that cause [[malabsorption]], [[chronic diarrhea]], joins involvement, and neurologic symptoms.
* Malabsorption with small-intestine involvement (celiac disease, sarcoidosis, and lymphoma)
* Malabsorption with small-intestine involvement (celiac disease, sarcoidosis, and lymphoma)
* Inflammatory rheumatic diseases
* Infections such as tuberculosis, endemic fungi (eg, Histoplasma spp), Rhodococcus and HIV infection
* Inflammatory bowel diseases
*Connective tissue diseases
*Connective tissue diseases
*Neurologic disease
*Neurologic disease

Revision as of 14:46, 25 October 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

Differentiating Whipple's disease from other Diseases

Whipple's disease must be differentiated from other diseases that cause malabsorption, chronic diarrhea, joins involvement, and neurologic symptoms.

  • Malabsorption with small-intestine involvement (celiac disease, sarcoidosis, and lymphoma)
  • Infections such as tuberculosis, endemic fungi (eg, Histoplasma spp), Rhodococcus and HIV infection
  • Inflammatory bowel diseases
  • Connective tissue diseases
  • Neurologic disease
  • Addison’s disease

The following diseases have presentations similar to that of Whipple's disease.

The table below summarizes the findings that differentiate fatty causes of chronic diarrhea[1][2][3]

Cause Osmotic gap History Physical exam Gold standard Treatment
< 50

mOsm

per kg

> 50

mOsm

per kg*

lactose intolerance - + Lactose breath hydrogen test Restriction of lactose and maintain calcium and vitamin D intake.
Celiac sprue - + Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody followed by upper endoscopy with biopsy. Dietary counseling, elimination of gluten in the diet.
Whipple disease - + Upper endoscopy with biopsies of the small intestine for T. whipplei testing (histology with PAS staining, polymerase chain reaction [[[PCR]]] testing, and immunohistochemistry) Doxycycline and hydroxychloroquine are bactericidal

References

  1. Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.
  2. Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.
  3. BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.

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