Thursday, May 30, 2013

Nourishment Barrier

A 49 year old male farmer has been bothered for years by a migratory arthralgia of the large joints. More recently, he's developed diarrhea, weight loss, abdominal pain, and severe wasting. His family has noted that he's been more confused as well. But most recently, he's developed a curious continuous rhythmic movement of eye convergence with concurrent contractions of the muscles of mastication. On exam, he has a vertical gaze palsy and a cerebellar ataxia. Labs rule out thyroid disease, connective tissue disease, inflammatory bowel disease, and HIV/AIDS. Labs show an elevated INR.

The patient undergoes endoscopy with small bowel biopsy, shown below.

Challenge: What's your diagnosis?

Image shown under fair use.


sid said...

What is Whipple's Disease??

sid said...

as in double jeopardy.. lol

city said...


Craig Chen said...

what is whipple's disease is correct
Nourishment Barrier

Tropheryma whipplei is the cause of Whipple’s disease; the title refers to trophe (nourishment) and eryma (barrier). It is a gram positive, non acid fast, periodic acid-Schiff positive bacillus. The pathology shows PAS-positive macrophages and villous atrophy.

Source: UpToDate.