Whipple's disease differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
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].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Differentiating X from other Diseases
- [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].
- [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
- As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
Differentiating Whipple's disease from other Diseases
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 | - | + |
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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 [[[PCR]]] testing, and immunohistochemistry) | Doxycycline and hydroxychloroquine are bactericidal | ||
Preferred Template Table
| Diseases | Laboratory Findings | Physical Examination | History and Symptoms | Other Findings | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lab Test 1 | Lab Test 2 | Lab Test 3 | Lab Test 4 | Physical Finding 1 | Physical Finding 2 | Physical Finding 3 | Physical Finding 4 | Finding 1 | Finding 2 | Finding 3 | Finding 4 | ||
| Differential Diagnosis 1 | + | ||||||||||||
| Differential Diagnosis 2 | ↑ | - | |||||||||||
| Differential Diagnosis 3 | ↓ | ||||||||||||
| Differential Diagnosis 4 | |||||||||||||
| Differential Diagnosis 5 | |||||||||||||
Use if the above table can not be made
| Differential Diagnosis | Similar Features | Differentiating Features |
|---|---|---|
| Differential 1 |
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| Differential 2 |
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| Differential 3 |
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| Differential 4 |
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| Differential 5 |
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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.