Baylor University Medical Center Proceedings October 2017 - 430

have shown that use of PCR techniques on intestinal biopsies
is not necessary to confirm the diagnosis. Additionally, PCR
tests risk contamination by environmental DNA, lack visual
controls, and are difficult to perform on paraffin sections (4). In
this case, the diagnosis was confirmed with periodic acid-Schiff
staining of duodenal biopsies as well as villous atrophy. Though
the Whipple's PCR test was negative, small bowel histology
was determined to be pathognomonic for Whipple's disease.
A dramatic response to targeted therapy further confirmed the
diagnosis.
Without treatment, Whipple's disease can be fatal and
even with treatment relapse can occur. This case illustrates

the importance of clinical suspicion driving a diagnosis and
indicates that current diagnostic methods for Whipple's disease
may be limited.
1.
2.
3.

4.

Desnues B, Ihrig M, Raoult D, Mege JL. Whipple's disease: a macrophage
disease. Clin Vaccine Immunol 2006;13(2):170-178.
Fenollar F, Puéchal X, Raoult D. Whipple's disease. N Engl J Med
2007;356(1):55-66.
Schneider T, Moos V, Loddenkemper C, Marth T, Fenollar F, Raoult D.
Whipple's disease: new aspects of pathogenesis and treatment. Lancet
Infect Dis 2008;8(3):179-190.
Fenollar F, Raoult D. Molecular techniques in Whipple's disease. Expert
Rev Mol Diagn 2001;1(3):299-309.

Avocations

Photo copyright © Jed Rosenthal, MD. Dr. Rosenthal is a cardiologist in Dallas, Texas (e-mail: jedr2@sbcglobal.net).

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