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Old 09-28-2012
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Arrow Gyrus Daily Questions; Internal Medicine #35

A 38-year-old male presents to his physician with 4 to 6 months of weight loss and joint complaints. He re-ports that his appetite is good, but he has had diarrhea with six to eight loose, foul-smelling stools each day. He has also had migratory pain in the knees and shoulders.
Stool studies demonstrate steatorrhea. Which of the fol-lowing diagnostic tests is most likely to be positive in this patient?


A. Serum IgA antiendomysial antibodies
B. Serum IgA antigliadin antibodies
C. Serum PCR for Tropheryma whippelii
D. Small bowel biopsy showing reduced villous height and crypt hyperplasia
E. Stool Clostridium difficile toxin
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Old 09-28-2012
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C. Serum PCR for Tropheryma whippelii
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Old 09-29-2012
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Answer C
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Quote:
Originally Posted by K06100 View Post
C. Serum PCR for Tropheryma whippelii
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Originally Posted by heartbeat View Post
Answer C

The answer is C.

The combination of steatorrhea, weight loss, and migratory large joint arthralgias is consistent with the diagnosis of Whipple’s disease.

Whipple’s disease may also cause cardiac and central nervous system (CNS) disease, including dementia. It is caused by chronic infection with T. whippelii.

The disease occurs predominantly in middle-aged white men. Whipple’s disease may also be diagnosed by a small bowel (or other involved organ) showing macrophages staining positive for PAS and containing the small Whipple’s bacillus.

Treatment for Whipple’s disease requires prolonged (1 year) therapy with trimethoprim-sulfamethoxazole or chloramphenicol.

Antiendomysial antibodies, antigliadin IgA antibodies, and the small bowel biopsy findings described above are characteristic of celiac sprue.

Antibiotic-associated colitis caused by C. difficile does not cause steatorrhea.

Last edited by cingulate.gyrus; 09-29-2012 at 03:41 AM. Reason: adding
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