Whipple's disease differential diagnosis: Difference between revisions
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| Line 24: | Line 24: | ||
{| class="wikitable" | {| class="wikitable" | ||
! rowspan="2" |Cause | ! rowspan="2" |Cause | ||
! colspan="2" |Osmotic gap | |||
! rowspan="2" |History | ! rowspan="2" |History | ||
! rowspan="2" |Physical exam | ! rowspan="2" |Physical exam | ||
| Line 29: | Line 30: | ||
! rowspan="2" |Treatment | ! rowspan="2" |Treatment | ||
|- | |- | ||
!< 50 | |||
mOsm | |||
per kg | |||
!> 50 | |||
mOsm | |||
per kg* | |||
|- | |- | ||
|[[lactose intolerance]] | |[[lactose intolerance]] | ||
| - | |||
| + | |||
| | | | ||
* [[Bloating|Bloating]] | * [[Bloating|Bloating,]] | ||
* [[Flatulence]] | * [[Flatulence]] | ||
* [[Abdominal pain]], and/or [[chronic diarrhea]] | * [[Abdominal pain]], and/or [[chronic diarrhea]] | ||
* | * after ingestion of [[lactose]] | ||
| | | | ||
* [[Abdominal]] [[tenderness ]]when palpated in severe [[disease]] | * [[Abdominal]] [[tenderness ]]when palpated in severe [[disease]] | ||
| Line 47: | Line 57: | ||
|- | |- | ||
|[[Celiac sprue]] | |[[Celiac sprue]] | ||
| - | |||
| + | |||
| | | | ||
* [[Diarrhea]] with bulky, [[Steatorrhea|foul-smelling stools]] | * [[Diarrhea]] with bulky, [[Steatorrhea|foul-smelling stools]] | ||
* [[Growth failure]] in children | * [[Growth failure]] in children, | ||
* [[Weight loss|Weight loss]] | * [[Weight loss|Weight loss,]] | ||
* [[Anemia]] | * [[Anemia]], | ||
* [[Neurologic diseases|Neurologic disorders]] | * [[Neurologic diseases|Neurologic disorders]] | ||
* [[Osteopenia]] | * [[Osteopenia]] | ||
| Line 67: | Line 79: | ||
|- | |- | ||
|[[Whipple's disease|Whipple disease]] | |[[Whipple's disease|Whipple disease]] | ||
| - | |||
| + | |||
| | | | ||
* [[Arthralgias]] | * [[Arthralgias]] | ||
Revision as of 14:56, 25 October 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
Differentiating Whipple's disease from other Diseases
Whipple's disease must be differentiated from other diseases that cause malabsorption, chronic diarrhea, joins involvement, and neurologic symptoms.
- Malabsorption with small intestine involvement (celiac disease, sarcoidosis, and lymphoma)
- Infections such as tuberculosis, endemic fungi (eg, Histoplasma spp), Rhodococcus and HIV infection
- Inflammatory bowel diseases
- Connective tissue diseases
- Neurologic disease
- Addison's disease
The following diseases have presentations similar to that of Whipple's disease.
The table below summarizes the findings that differentiate fatty causes of chronic diarrhea[1][2][3]
| Cause | Osmotic gap | History | Physical exam | Gold standard | Treatment | |
|---|---|---|---|---|---|---|
| < 50
mOsm per kg |
> 50
mOsm per kg* | |||||
| lactose intolerance | - | + |
|
|
Lactose breath hydrogen test | Restriction of lactose and maintain calcium and vitamin D intake. |
| Celiac sprue | - | + |
|
Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody followed by upper endoscopy with biopsy. | Dietary counseling, elimination of gluten in the diet. | |
| Whipple disease | - | + | Upper endoscopy with biopsies of the small intestine for T. whipplei testing (histology with PAS staining, polymerase chain reaction testing, and immunohistochemistry) | Doxycycline and hydroxychloroquine are bactericidal | ||
References
- ↑ Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.
- ↑ Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.
- ↑ BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.