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  #1  
Old 04-03-2010
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Question grocer with diarrhea and painful arthritis

a 47-yo grocer complains of diarrhea and painful athritis. physical examination is remarkable for lymphadenopathy and weight loss. biopsy of his small bowel reveals PAS-positive macrophages within the lamina propria. EM of the macrophages reveal small, rod shaped structures. which of the following is the most likely pathogen?
a. clostridium difficile
b. ETEC
c. Isospora Belli
d. salmonella spp.
e. tropheryma whippelii


this question made me go NUTS!! (its important to read up on material other than kaplan too.. .. albeit im still sticking to kaplan primarily )
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  #2  
Old 04-03-2010
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Middle aged man + PAS positive Micro-organisms is Whipple's disease without second thought (correct answer is E). What you mentioned is absolutely true; be always ready to retrieve information from whichever source (although I thought both Kaplan & FA mention this entity).
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Old 04-03-2010
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hi good one.
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Old 04-03-2010
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Very good one
The answer is E-Tropheryma whippelii The patient can also have malabsorbption because macrophages obstruct the reabsorption of chylomicrons (stetorrhea) ,sometimes hyperpigmentation.
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Old 04-03-2010
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e. tropheryma whippelii, most likely
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Old 04-04-2010
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Arrow Whipple's Disease Threads

This is a nice question

I'd like to bring your attention to these two related threads
Cognitive loss + Joint aches + Nystagmus + Diarrhea
and
Diarrhea and Weight Loss!
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