Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.13044
Peer-review started: August 31, 2022
First decision: October 12, 2022
Revised: October 30, 2022
Accepted: November 18, 2022
Article in press: November 28, 2022
Published online: December 16, 2022
Processing time: 99 Days and 19.4 Hours
Whipple’s disease is a rare systemic infection caused by Tropheryma whipplei. Most patients present with nonspecific symptoms, and routine laboratory and imaging examination results also lack specificity. The diagnosis often relies on invasive manipulation, pathological examination, and molecular techniques. These difficulties in diagnosing Whipple’s disease often result in misdiagnosis and inappropriate treatments.
This paper reports on the case of a 58-year-old male patient who complained of fatigue and decreased exercise capacity. The results of routine blood tests indicated hypochromic microcytic anemia. Results of gastroscopy and capsule endoscopy showed multiple polypoid bulges distributed in the duodenal and proximal jejunum. A diagnosis of small intestinal adenomatosis was initially considered; hence, the Whipple procedure, a pylorus-preserving pancreaticoduodenectomy, was performed. Pathological manifestations showed many periodic acid-Schiff-positive macrophages aggregated in the intestinal mucosa of the duodenum, upper jejunum, and surrounding lymph nodes. Based on comprehensive analysis of symptoms, laboratory findings, and pathological manifestations, the patient was finally diagnosed with Whipple’s disease. After receiving 1 mo of antibiotic treatment, the fatigue and anemia were significantly improved.
This case presented with atypical gastrointestinal manifestations and small intestinal polypoid bulges, which provided new insight on the diagnosis of Whipple’s disease.
Core Tip: Whipple’s disease is a rare disease diagnosed by invasive manipulation. We reported on the case of a 58-year-old male patient who complained of fatigue and decreased exercise capacity. Results of gastroscopy and capsule endoscopy showed multiple polypoid bulges distributed in the duodenal and proximal jejunum. A diagnosis of small intestinal adenomatosis was initially considered; hence, the Whipple procedure, a pylorus-preserving pancreaticoduodenectomy, was performed. Many polyglandular autoimmune syndromes-positive macrophages aggregated in the intestinal mucosa of the duodenum, upper jejunum, and surrounding lymph nodes. Based on comprehensive analysis of symptoms, laboratory findings, and pathological manifestations, the patient was finally diagnosed with Whipple’s disease.