A 46yo man is being investigated for indigestion. Jejunal biopsy shows deposition of
macrophages containing PAS (Periodic acid-schiff) +ve granules. What is the most likely dx?
a. Bacterial overgrowth
b. Celiac disease
c. Tropical sprue
d. Whipple’s disease
e. Small bowel lymphoma
answer: D
a small-bowel biopsyfull of periodic acid-Schiff–positive macrophages = whipple’s disease
villous atrophy, lymphocytes, plasma cells, crypt hyperplasia = celiac