A 45-year-old man from South India presents with chronic diarrhea, weight loss, and macrocytic anemia. Duodenal biopsy shows partial villous atrophy with increased intraepithelial lymphocytes. He has no response to a gluten-free diet. Which organism is most likely responsible?

• A Tropheryma whipplei
• B Mycobacterium avium complex
• C Giardia lamblia
• D Enterotoxigenic Escherichia coli ✓

Explanation

Tropical sprue is endemic in South and Southeast India and presents with chronic diarrhea, malabsorption, and macrocytic anemia with villous atrophy on biopsy. It is thought to be due to chronic intestinal infection, classically with enterotoxigenic E. coli or Klebsiella. It responds to tetracycline and folate supplementation, unlike celiac disease which responds to gluten-free diet. Whipple disease shows PAS-positive macrophages on biopsy.

Reference: Davidson's Principles and Practice of Medicine, 24th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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