Browsing by Subject "Electron Microscopy"

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    Nearly Fatal Case of Whipple's Disease in a Patient Mistakenly on Anti-TNF Therapy
    (American College of Gastroenterology, 2013-10) Klochan, Christen; Anderson, Teresa A.; Rose, Dusten; Dimitrov, Rosen K.; Johnson, Raymond M.; Department of Pathology and Laboratory Medicine, IU School of Medicine
    Whipple's disease is a rare cause of chronic diarrhea and abdominal pain that may be confused with inflammatory bowel disease. We report a Whipple's case misdiagnosed as Crohn's disease in which treatment with anti-tumor necrosis factor (anti-TNF) therapy led to nearly fatal progression. Lymph node tissue obtained during laparotomy for suspected bowel necrosis stained dramatically with periodic acid-Schiff (PAS), and electron microscopy showed a bacterium consistent with Trophyrema whipplei. The patient made a remarkable recovery complicated only by cholestatic hepatitis, which was likely a treatment-associated inflammatory response. This case serves as a reminder that all granulomatous infections should be considered prior to initiation of anti-TNF therapies.