AN UNUSUAL PRESENTATION OF WHIPPLE’S DISEASE: A YOUNG MALE PRESENTING WITH CHRONIC DIARRHEA

Abstract

WD is a rare, multisystem, chronic infection caused by the Tropherima whipplei primarily involving the small intestine. The patient presents with diarrhea, weight loss, abdominal pain, and fever. The series of endoscopic evaluation, histopathology, and PCR assays are essential, however, histopathologically, the presence of sheets of foamy macrophages is the key suspicion leading to diagnosis. An 18-year-old boy presented with severe abdominal pain accompanied by severe diarrhea with episodes of intermittent constipation. He underwent a series of gastro-endoscopic and colonoscopic examinations. The tissue blocks after reviewing showed sheets of macrophages in lamina propria suggesting a provisional diagnosis of Whipple’s disease. The patient was treated by injection of Oxidil 2g OD for two weeks and Septran DS BD. This treatment led to the improvement of symptoms i.e., diarrhea and weight loss. In the resource-limited setting, where repetition of tissue block review leads to exhaustion and the economic burden of repetitive endoscopic procedures on patients is laborious. The presence of foamy macrophages plays a pivotal role in patient management, ultimately leading to symptomatic improvement.