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Whipple's disease with normal duodenal histology diagnosed by ileal biopsy using balloon endoscopy. Clin J Gastroenterol 2022; 15:702-707. [PMID: 35522379 DOI: 10.1007/s12328-022-01638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
A 34 year-old previously healthy Japanese woman presented with a 4 year history of migratory arthralgia, chronic diarrhea, mild fever, and 10 kg weight loss. She was initially misdiagnosed with seronegative arthritis, followed by eosinophilic gastroenteritis. Oral prednisolone was found to be ineffective. Upper endoscopy revealed normal duodenal mucosa. Duodenal biopsy specimen indicated no abnormalities. However, balloon endoscopy revealed white shaggy villi in the ileum, and a biopsy specimen from which revealed diffuse infiltration of foamy macrophages in the lamina propria. These macrophages contained diastase-periodic acid-Schiff positive granules, consistent with Whipple's disease. Polymerase chain reaction analysis of DNA extracted from the ileum was compatible with Whipple's disease. In most previously reported cases of Whipple's disease, the duodenum was affected and duodenal biopsy specimens led to a diagnosis of Whipple's disease. Whipple's disease with normal duodenal histology is extremely rare and balloon endoscopy might be a useful diagnostic tool in such a case. The patient was treated with intravenous ceftriaxone and oral trimethoprim-sulfamethoxazole, and her symptoms improved one month after treatment. Balloon endoscopy performed 32 months later revealed complete improvement in lesions of the ileum.
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Kunogi T, Ando K, Fujiya M. Balloon endoscopy and capsule endoscopy are useful in the diagnosis of small bowel lesions in Whipple's disease. Dig Endosc 2022; 34:248. [PMID: 34716947 DOI: 10.1111/den.14180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Takehito Kunogi
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido, Japan
| | - Katsuyoshi Ando
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido, Japan
| | - Mikihiro Fujiya
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido, Japan
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Role of enteroscopy in the diagnosis of whipple's disease. Acta Gastroenterol Belg 2021; 84:669-671. [PMID: 34965051 DOI: 10.51821/84.4.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Whipple's disease is a rare chronic systemic infection caused by Tropheryma whipplei. The widespread infection by this rod is responsible for the protean clinical manifestations of the disease, although its classical form is notable for the prevalence of abdominal symptoms such as chronic diarrhea and abdominal pain. Whitish-yellow patches, suggestive of lymphangiectasia, are typically observed in the duodenum during upper endoscopy. The diagnosis of this condition is supported by the identification in duodenal biopsies of Periodic acid-Schiff staining within lamina propria macrophages. Nevertheless, a significant portion of patients do not have lesions within the range of conventional upper endoscopy. Therefore, other endoscopic procedures such as video capsule endoscopy and enteroscopy may be useful to detect more distal lesions. The authors describe a case where the combined used of both techniques allowed the unmasking of this disease.
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Alimetov AY, Poliakov PP, Onopriev AV, Avakimyan AV, Zanin SA, Kade AK. Сapsule endoscopy for diagnosis of celiac disease. TERAPEVT ARKH 2019; 91:91-96. [PMID: 31094178 DOI: 10.26442/00403660.2019.02.000068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this review we analyzed the guidelines for diagnosis and management of celiac disease, as well as the recent studies published on this issue. Capsule endoscopy could be used in patients unwilling or unable to undergo conventional endoscopy, in patients who have discordant results between serological and histopathological investigation, in patients with nonresponsive or refractory celiac disease.
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Affiliation(s)
- A Ya Alimetov
- Kuban State Medical University of the Ministry of Health of the Russian Federation, Krasnodar, Russia.,Krasnodar Municipal Clinical Emergency Hospital, Krasnodar, Russia
| | - P P Poliakov
- Kuban State Medical University of the Ministry of Health of the Russian Federation, Krasnodar, Russia
| | - A V Onopriev
- Kuban State Medical University of the Ministry of Health of the Russian Federation, Krasnodar, Russia
| | - A V Avakimyan
- Regional Clinical Hospital №2, Krasnodar, Russia.,Klinika-A OOO (Limited Liability Company), Krasnodar, Russia
| | - S A Zanin
- Kuban State Medical University of the Ministry of Health of the Russian Federation, Krasnodar, Russia
| | - A Kh Kade
- Kuban State Medical University of the Ministry of Health of the Russian Federation, Krasnodar, Russia
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D'Apice MR, Novelli A, di Masi A, Biancolella M, Antoccia A, Gullotta F, Licata N, Minella D, Testa B, Nardone AM, Palmieri G, Calabrese E, Biancone L, Tanzarella C, Frontali M, Sangiuolo F, Novelli G, Pallone F. Deletion of REXO1L1 locus in a patient with malabsorption syndrome, growth retardation, and dysmorphic features: a novel recognizable microdeletion syndrome? BMC MEDICAL GENETICS 2015; 16:20. [PMID: 25927938 PMCID: PMC4422118 DOI: 10.1186/s12881-015-0164-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 03/12/2015] [Indexed: 12/27/2022]
Abstract
Background Copy number variations (CNVs) can contribute to genetic variation among individuals and/or have a significant influence in causing diseases. Many studies consider new CNVs’ effects on protein family evolution giving rise to gene duplicates or losses. “Unsuccessful” duplicates that remain in the genome as pseudogenes often exhibit functional roles. So, changes in gene and pseudogene number may contribute to development or act as susceptibility alleles of diseases. Case presentation We report a de novo heterozygous 271 Kb microdeletion at 8q21.2 region which includes the family of REXO1L genes and pseudogenes in a young man affected by global development delay, progeroid signs, and gastrointestinal anomalies. Molecular and cellular analysis showed that the REXO1L1 gene hemizygosity in a patient’s fibroblasts induces genetic instability and increased apoptosis after treatment with different DNA damage-induced agents. Conclusions The present results support the hypothesis that low copy gene number within REXO1L1 cluster could play a significant role in this complex clinical and cellular phenotype.
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Affiliation(s)
| | - Antonio Novelli
- Mendel Institute, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
| | | | - Michela Biancolella
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.
| | | | - Francesca Gullotta
- Department of Biology, "Roma Tre" University, Rome, Italy. .,Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.
| | - Norma Licata
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy. .,Department of Neuroscience, Psychiatry and Anaesthesiology, University of Messina, Messina, Italy.
| | - Daniela Minella
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.
| | - Barbara Testa
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.
| | | | | | - Emma Calabrese
- Department of Internal Medicine, Gastrointestinal Unit, Tor Vergata University of Rome, Rome, Italy.
| | - Livia Biancone
- Department of Internal Medicine, Gastrointestinal Unit, Tor Vergata University of Rome, Rome, Italy.
| | | | | | - Federica Sangiuolo
- Fondazione Policlinico Tor Vergata, Rome, Italy. .,Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.
| | - Giuseppe Novelli
- Fondazione Policlinico Tor Vergata, Rome, Italy. .,Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy. .,San Pietro Fatebenefratelli Hospital, Rome, Italy.
| | - Francesco Pallone
- Department of Internal Medicine, Gastrointestinal Unit, Tor Vergata University of Rome, Rome, Italy.
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de Roulet J, Hassan MO, Cummings LC. Capsule endoscopy in Whipple's disease. Clin Gastroenterol Hepatol 2013; 11:A26. [PMID: 23376325 PMCID: PMC3805739 DOI: 10.1016/j.cgh.2013.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 01/08/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Jason de Roulet
- Division of Gastroenterology & Liver Disease, University Hospitals Case Medical Center,Division of Gastroenterology & Liver Disease, Louis Stokes Cleveland VA Medical Center
| | - Medhat O. Hassan
- Department of Pathology, Louis Stokes Cleveland VA Medical Center
| | - Linda C. Cummings
- Division of Gastroenterology & Liver Disease, University Hospitals Case Medical Center,Division of Gastroenterology & Liver Disease, Louis Stokes Cleveland VA Medical Center
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Mateescu BR, Bengus A, Marinescu M, Staniceanu F, Micu G, Negreanu L. First Pillcam Colon 2 capsule images of Whipple’s disease: Case report and review of the literature. World J Gastrointest Endosc 2012; 4:575-8. [PMID: 23293729 PMCID: PMC3536856 DOI: 10.4253/wjge.v4.i12.575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 03/04/2012] [Accepted: 10/10/2012] [Indexed: 02/05/2023] Open
Abstract
Whipple’s disease is a rare chronic systemic infection determined by the Gram-positive bacillus Tropheryma whipplei. The infection usually mainly involves the small bowel, but sometimes other organs are affected as well. Since the current standard clinical and biological tests are nonspecific, diagnosis is very difficult and relies on histopathology. Here we present the case of a 52-year-old man with chronic diarrhea and weight loss whose symptoms had been evolving for 2 years and whose diagnosis came unexpectedly after capsule examination. Diagnosis was confirmed by the histopathologic examination of endoscopic biopsy samples, and treatment with co-trimoxazole resulted in remission of symptoms. We present the first images of Whipple’s disease obtained with the Pillcam Colon 2 video capsule system.
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Affiliation(s)
- Bogdan Radu Mateescu
- Bogdan Radu Mateescu, Andreea Bengus, Madalina Marinescu, Department of Gastroenterology, Colentina Hospital, Bucharest 50098, Romania
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