Snapshot A 45-year-old woman presents to her primary care physician with a complaints of unintentional weight loss. She denies any fevers or night sweats. She does report having frequent diarrhea as well as pale, foul-smelling bowel movements. She recently went on a trip to the Carribbean. On physical exam, she appears thin but her physical exam is otherwise insignificant. Serum labs reveal increased prothrombin time. A small bowel biopsy shows the presence of PAS-negative microorganisms. She is started on antibiotics. (Tropical sprue) Introduction Overview login to view 4 more bullets Epidemiology etiology login to view 10 more bullets Pathogenesis mechanism login to view 9 more bullets Presentation History login to view 1 more bullet Symptoms login to view 11 more bullets Vitamin Deficiencies Vitamin A Deficiency Vitamin D Deficiency Vitamin E Deficiency Vitamin K Deficiency Night blindness Xeroderma Osteomalacia Ricketts Hemolytic anemia Muscle weakness Paresthesias Bleeding Easy bruising Imaging Abdominal computed tomography login to view 2 more bullets Studies Serum labs login to view 6 more bullets Invasive studies login to view 27 more bullets Differential Fat Malabsorption Syndromes Celiac Disease Whipple Disease Pancreatic Insufficiency Tropical Sprue Fat malabsorption Pale, bulky, and foul-smelling stools Pale, bulky, and foul-smelling stools Pale, bulky, and foul-smelling stools Pale, bulky, and foul-smelling stools Unique clinical features Positive autoantibodies Dermatitis herpetiformis Triad: cardiac symptoms arthralgia neurologic symptoms Caused by Tropheryma whipplei, a gram-positive rod History of alcoholism History of previous episodes of pancreatitis History of being in tropical regions or South Asia Negative autoantibodies Megaloblastic anemia due to folate and vitamin B12 deficiences Diagnostic testing Small bowel biopsy Abnormal D-xylose test Autoantibodies Small bowel biopsy Polymerase chain reaction of stool showing T. whipplei Abnormal D-xylose test Abdominal CT scan Secretin stimulation testing Small bowel biopsy Abnormal D-xylose test Treatment Dietary restrictions: avoid gluten Ceftriaxone Trimethoprim/sulfamethoxazole Tetracycline Enzyme replacement therapy Tetracyclines Treatment Lifestyle login to view 5 more bullets Medical login to view 17 more bullets Surgical login to view 1 more bullet Complications Malnutrition