Question

A 30-year-old man presents with a 1-year history of watery diarrhea. He has lost 5 kg. He has joint pains of 1-month duration. His stool examination for occult blood is negative. Stool culture is negative. No ova and cyst are seen in the stool. Laboratory tests fail to reveal rheumatoid factor or anti-nuclear antibodies. Serum calcium, phosphorous and alkaline phosphatase is 9.2 mg/dl, 4 mg/dl and 110 U/L respectively. A biopsy taken from the upper intestine shows distended macrophages in the lamina propria, which is found to be positive with PAS stain.

What is the most likely diagnosis in this case?

1. Celiac sprue
2. Tropical sprue
3. Whipple disease
4. Disaccharidase deficiency
5. Amebic dysentery

Answer 1

A 30-year-old man with chronic watery diarrhea, weight loss, joint pain, and specific biopsy findings is most likely diagnosed with Whipple disease, considering the presence of PAS-positive macrophages in the intestinal mucosa and the exclusion of other similar conditions.

Step-by-step explanation:

The clinical presentation of a 30-year-old man with a 1-year history of watery diarrhea, weight loss, joint pains, and a negative stool examination for occult blood, ova, and cysts suggests a systemic disorder involving the gastrointestinal tract. Given the biopsy findings of distended macrophages in the lamina propria of the upper intestine positive with PAS stain, the most likely diagnosis is Whipple disease. This condition is characterized by the accumulation of PAS-positive macrophages in the intestinal mucosa, leading to malabsorption and systemic symptoms. The patient's symptoms do not align well with celiac disease, tropical sprue, disaccharidase deficiency, or amebic dysentery, and the absence of serological markers for rheumatoid factor and anti-nuclear antibodies further supports this diagnosis.