Bridgeport Hospital, Yale University School of Medicine Bridgeport, CT, United States
Patricia Garcia, MD1, Christopher Theriau, MD, PhD2, Caroline Loeser, MD1, Lauren Mays, BS3 1Bridgeport Hospital, Yale University School of Medicine, Bridgeport, CT; 2University of Toronto, Bridgeport, CT; 3Saba University School of Medicine, Bridgeport, CT
Introduction: Whipple’s disease is not commonly encountered in clinical practice. Patients presenting without risk factors is even rarer. We present a case of a young male without any known risk factors for disease transmission who presented with a history of unintentional weight loss and chronic diarrhea resulting in cachexia without any other history of classic symptoms.
Case Description/Methods: 28-year-old African American male with a history of type I diabetes mellitus presented to the hospital from his outpatient visit due to hypotension. The patient endorsed chronic diarrhea for 4 years and an unintentional 53 kg weight loss (BMI 13.5 on admission) over the past 6 years. He reported his bowel movements were associated with oral intake and described the stool as varying between loose and watery. Denied history of abdominal pain, cramping, tenesmus, nausea, vomiting or arthralgias. Social and surgical history were unremarkable.
Exam revealed normal vital signs except for a blood pressure of 92/55 mmHg and cachexia . Laboratorial findings revealed negative C. Diff PCR, HIV, cryptosporidium, cyclospora, giardia, ova and parasite, TSH, fecal calprotectin, celiac serologies, stool culture, VIP, gastrin, 5-HIAA, cortisol. Low levels of vitamin D, A and K led pancreatic insufficiency to be initially considered. Fecal elastase and chymotrypsin were within normal range.
Endoscopy and colonoscopy grossly were unremarkable. Initial biopsies showed no signs of active inflammation, parasites or villous atrophy in duodenal and ileal samples. Samples were sent for AFB staining/culture and RT-PCR for T. Whipplei. AFB staining revealed no organisms and cultures were negative .Both duodenal and ileal samples were positive for T. Whipplei DNA.
To address his malnutrition, he was started on TPN. CSF was collected prior to initiation of antibiotic therapy and sent for PCR which returned negative. The patient was treated with 2g IV Ceftriaxone.
Discussion: Although Whipple’s disease is extremely rare in the US, after a thorough investigation into weight loss and chronic diarrhea, rarer causes of malabsorption must be considered. Whipple’s disease should be considered in patients with chronic diarrhea and weight loss of unknown origins after extensive initial workup, even in the absence of classic symptoms or risk factors for transmission. Clinicians must always remain vigilant of this infectious etiology under these circumstances as a delay in diagnosis leads to considerable morbidity and possible mortality.
Disclosures:
Patricia Garcia indicated no relevant financial relationships.
Christopher Theriau indicated no relevant financial relationships.
Caroline Loeser indicated no relevant financial relationships.
Lauren Mays indicated no relevant financial relationships.
Patricia Garcia, MD1, Christopher Theriau, MD, PhD2, Caroline Loeser, MD1, Lauren Mays, BS3. P2001 - Whipple’s Disease Diagnosed by Enteroscopy: A Rare Case of a Young Male in the United States, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.