BOF: 53
A 50-year-old man presents with malaise, weight loss,
diarrhoea and pain in the joints. He is pigmented, has clubbing and
lymphadenopathy. He has ascites and ophthalmoplegia. Investigations show him to be anaemic. ECG shows a right
bundle branch block and paracentesis abdominis reveals chylous ascites.
The investigation most likely to give a diagnosis would
be:
a)
Lumbar puncture
b)
CT head
c)
Ascitic fluid cytology
d)
Small bowel biopsy
e)
Transoesphageal echocardiography
Answer:
d)
The patient has Whipple’s disease, which is diagnosed
by the demonstration of multiple macrophages in the lamina propria and the
presence of rod shaped bacteria both within and without the abnormal
macrophages.
Whipple's Disease
