In which ofthe following conditions ofmalabsorption, an intestinal biopsy is diagnostic –
Correct Answer: Whipple's disease
Description: Clinical features Middle-aged Caucasian men are most frequently affected and presentation depends on the pattern of organ involvement. Low-grade fever is common and most patients have joint symptoms to some degree, often as the first manifestation. Occasionally, neurological manifestations may predominate and CNS involvement is the most serious consequence. Investigations Diagnosis is made by the characteristic features on small bowel biopsy, with characterisation of the bacillus by polymerase chain reaction (PCR). Management Whipple's disease is often fatal if untreated but responds well, at least initially, to intravenous ceftriaxone (2 g daily for 2 weeks), followed by oral co-trimoxazole for at least 1 year. Symptoms Ref Davidson edition23rd pg 809
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