Whipple's disease

Question 1

Causative organism?

Answer 1

Tropheryma whippelii

Question 2

Who is this more common in?

Answer 2

Patients who are HLA-B27 positive and in middle-aged men.

Question 3

Symptoms?

Answer 3

• malabsorption: diarrhoea, weight loss
• large-joint arthralgia
• lymphadenopathy
• skin: hyperpigmentation and photosensitivity
• pleurisy, pericarditis
• neurological symptoms (rare): ophthalmoplegia,
  dementia, seizures, ataxia, myoclonus

Question 4

Investigation?

Answer 4

Jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules

Question 5

Management?

Answer 5

Oral co-trimoxazole for a year is thought to have the lowest relapse rate, sometimes preceded by a course of IV penicillin