A patient is being investigated for chronic diarrhoea. Small intestinal mucosal biopsy shows PAS positive foamy macrophages. The diagnosis is probably –
**Core Concept**
The presence of PAS (Periodic Acid-Schiff) positive foamy macrophages in small intestinal mucosal biopsy indicates an accumulation of abnormal lipid droplets within these cells, suggestive of a lysosomal storage disorder. This condition is characterized by the breakdown of sphingolipids, leading to their accumulation in lysosomes of various cells, including macrophages in the gut.
**Why the Correct Answer is Right**
The correct answer is likely Whipple's disease, a rare systemic bacterial infection caused by *Tropheryma whipplei*. The bacteria invade the intestinal mucosa, leading to the accumulation of PAS-positive foamy macrophages, which are loaded with the bacteria and the host's cellular debris. This condition is often associated with malabsorption, including chronic diarrhoea, weight loss, and abdominal pain. The bacteria can also infect other organs, including the lungs, heart, and central nervous system.
**Why Each Wrong Option is Incorrect**
**Option A:** Crohn's disease is a type of inflammatory bowel disease characterized by chronic inflammation of the gastrointestinal tract, but it does not typically present with PAS-positive foamy macrophages.
**Option B:** Celiac disease is an autoimmune disorder that causes an immune response to gluten, leading to inflammation and damage in the small intestine. While it can cause chronic diarrhoea, it is not associated with PAS-positive foamy macrophages.
**Option C:** Giardiasis is an infection caused by the protozoan parasite *Giardia lamblia*, which can cause chronic diarrhoea and malabsorption. However, it does not typically present with PAS-positive foamy macrophages.
**Clinical Pearl / High-Yield Fact**
Whipple's disease is a classic example of a systemic bacterial infection that can mimic a variety of other conditions, including inflammatory bowel disease and malabsorption syndromes. A high index of suspicion and a thorough diagnostic workup, including small intestinal biopsy, are essential for making a diagnosis.
**Correct Answer:** D.