Whipple's disease differential diagnosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
Whipple's disease must be differentiated from other diseases that cause malabsorption, chronic diarrhea, multi system involvement, such as Celiac disease, systemic infections, and inflamatory bowel disease.
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 | History | Physical exam | Diagnostic test | Treatment |
|---|---|---|---|---|
| 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 testing, and immunohistochemistry) | Doxycycline and hydroxychloroquine are bactericidal |
References
- ↑ 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.
- ↑ 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.
- ↑ 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.