A 50-year-old male patient presented to the OPD with non-destructive migratory ahritis involving left lower limb joints along with intermittent episodes of fever and myalgias. Patient also complained of multiple episodes of diarrhea along with abdominal pain and significant weight loss. O/E, Cervical lymphadenopathy Hepatosplenomegaly Skin hyperpigmentation Mild anterior uveitis Lab finding revealed negative RA factor and ANA Ab tests, anemia and hypereosinophilia. Endoscopy was done and it revealed pale, yellow, shaggy mucosa with erythema and ulceration past the 1st pa of duodenum. Biopsy from the small intestine was taken and PAS staining was done. PCR was ordered to diagnose the above condition. Which RNA sequencing is used to diagnose the above condition: -
This is a case of Whipple's disease. 1st image shows Endoscopic view of the jejunal mucosa demonstrating a thickened, granular mucosa and "white spots" due to dilated lacteals. 2nd image shows PAS +ve macrophages in the lamina propria of the small intestine. Whipple's disease: - Caused by gram positive bacteria, Tropheyrma whipplei Presents as malabsorption along with joints, central nervous system, and cardiovascular system. Biopsies of tissue samples from the small bowel show expanded villi containing macrophages staining positive with periodic acid-Schiff stain. A generic 16S rRNA bacterial assay is used to detect and identify T. whipplei sequence.
16S rRNA
28S rRNA
14S rRNA
40S rRNA
Integrated QBank