Whipple's disease differential diagnosis

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

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Overview

Whipple's disease must be differentiated from celiac disease, chronic diarrhea, clonorchiasis, and Parkinson's disease.

Differentiating Whipple's disease from other Diseases

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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