A Stain in Time

A CLINICAL PROBLEM-SOLVING article by Jeremy Jones from University of Toronto, Canada.
A 45-year-old woman from northern Ontario presented to her local hospital with a 2-year history of asymmetric migratory arthralgias involving the left knee, ankles, elbows, and fingers. She also had morning stiffness, increasing fatigue, an erythematous, nonpruritic rash after sun exposure, and a 3-month history of chest pain that was relieved when she was in an upright position. She did not have fevers, dry eyes or mouth, oral ulcers, or eye irritation or pain.
The patient's physicians made a diagnosis of seronegative lupus and started treatment with hydroxychloroquine. However, this conclusion was premature; the patient did not meet formal criteria for the diagnosis, antinuclear antibody–negative lupus is rare, and other more common conditions (such as inflammatory bowel disease and chronic infections) warranted consideration first. As the case unfolded over a period of several years, the chronic nature of the illness, the evolution of new constitutional symptoms, and the manifestations of malabsorption led to reconsideration of the initial diagnostic hypothesis and ultimately to conclusive diagnostic testing of duodenal tissue and cerebrospinal fluid.

Whipple病に関する資料

• Whipple's Disease via NEJM 
• Whipple病は病理学者により1907年に初めて報告された疾患 via 感染症の病理学的考え方 
• Whipple 病はマクロファージ内のPAS陽性物質と脂質沈着が特徴 via 感染症の病理学的考え方