An unusual cause of pancytopenia: Whipple's disease.
Whipple's disease is a systemic infectious disease caused by the bacteria Tropheryma whipplei. The most common clinical manifestations of Whipple's disease are weight loss (92%), hypoalbuminemia and steatorrhea (91%, respectively), diarrhea (72%), arthralgia (67%), and abdominal pain (55%). Neurological signs and symptoms from dementia to oculomasticatory myorhythmia or oculofacioskeletal myorhythmia (pathognomonic of Whipple's disease), lymphadenopathy, and fatigue can also be present. Pancytopenia is a rare and less recognized clinical feature in Whipple's disease patients. We are describing a case where a middle-aged Caucasian male diagnosed with Whipple's disease was found to have pancytopenia. Etiology of pancytopenia is postulated to be due to the invasion of bone marrow by T. whipplei. It is important to recognize that bone marrow involvement by the Whipple bacillus is not uncommon. In the presence of lymphadenopathy and pancytopenia, clinicians should think of Whipple's disease as a differential diagnosis apart from lymphoma or other non-specific granulomatous reticuloendothelial disorders.
Department of Internal Medicine, School of Medicine, Easton Hospital, Residency Program, Affiliated with Drexel University, Easton, PA, USA.
Nay T
NT
Tun
Department of Internal Medicine, School of Medicine, Easton Hospital, Residency Program, Affiliated with Drexel University, Easton, PA, USA.
Shwetanshu
S
Shukla
Department of Internal Medicine, School of Medicine, Easton Hospital, Residency Program, Affiliated with Drexel University, Easton, PA, USA.
Jaykrishnan
J
Krishnakurup
Department of Internal Medicine, School of Medicine, Easton Hospital, Residency Program, Affiliated with Drexel University, Easton, PA, USA.
Binu
B
Pappachen
Department of Internal Medicine, School of Medicine, Easton Hospital, Residency Program, Affiliated with Drexel University, Easton, PA, USA.
Mahesh
M
Krishnamurthy
Hematology and Oncology Department, School of Medicine, Easton Hospital, Easton, PA, USA.
Hayman
H
Salib
PAS positive macrophages; Tropheryma whipplei; bone marrow invasion; pancytopenia