A 55-year-old man presents with watery diarrhea (8–10 episodes/day), weight loss, and peripheral edema. Endoscopy shows villous atrophy and a thickened, pale-pink appearance of the small bowel mucosa. Biopsy shows PAS-positive, diastase-resistant macrophages in the lamina propria. What is the treatment?
- A Gluten-free diet
- B Trimethoprim-sulfamethoxazole for 12 months ✓
- C Rifaximin for bacterial overgrowth
- D Elemental diet and bowel rest
Explanation
PAS-positive, diastase-resistant macrophages in the small bowel lamina propria on biopsy are pathognomonic of Whipple's disease (Tropheryma whipplei infection). The infection is systemic and requires long-term antibiotic treatment: initial induction with ceftriaxone 2g IV for 2 weeks (or procaine penicillin), followed by trimethoprim-sulfamethoxazole (TMP-SMX) for 12–24 months to prevent CNS relapse. Without treatment, Whipple's disease is uniformly fatal. Gluten-free diet is for celiac disease. The distinctive histological finding distinguishes Whipple's from other causes of malabsorption.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.