Chronic inflammation: Whipple disease: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Chronic inflammation: Whipple disease

Sample item

A 45-year-old man has weight loss, steatorrhoea, migratory arthralgia and low-grade fever. A small bowel biopsy shows a lamina propria packed with foamy macrophages containing PAS-positive, diastase-resistant granules. Ziehl-Neelsen staining is negative. What is the causative agent?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Tropheryma whipplei

Whipple disease is a systemic infection by the Gram-positive actinomycete Tropheryma whipplei, mostly in middle-aged men, with malabsorption, arthropathy and sometimes neurological disease. The macrophage granules are the partly digested bacteria. Mycobacterium avium complex gives a similar macrophage infiltrate in AIDS but is acid-fast.

Option by option

  • A. Giardia lamblia

    Giardia trophozoites live in the intestinal lumen and do not fill the lamina propria with macrophages.

  • B. Mycobacterium avium complex

    Mycobacterium avium complex is acid-fast, and it infects patients with advanced HIV disease.

  • C. Cryptosporidium parvum

    Cryptosporidium sits on the brush border of enterocytes and does not produce foamy macrophages.

  • D. Tropheryma whipplei (correct)

    PAS-positive, acid-fast-negative macrophages in the lamina propria identify Tropheryma whipplei.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Tropheryma whipplei. Whipple disease is a systemic infection by the Gram-positive actinomycete Tropheryma whipplei, mostly in middle-aged men, with malabsorption, arthropathy and sometimes neurological disease.

Why is "Giardia lamblia" not the answer?

Giardia trophozoites live in the intestinal lumen and do not fill the lamina propria with macrophages.

Why is "Mycobacterium avium complex" not the answer?

Mycobacterium avium complex is acid-fast, and it infects patients with advanced HIV disease.

Why is "Cryptosporidium parvum" not the answer?

Cryptosporidium sits on the brush border of enterocytes and does not produce foamy macrophages.

What concept does this question test?

It tests Chronic inflammation: Whipple disease in Pathology. The macrophage granules are the partly digested bacteria. Mycobacterium avium complex gives a similar macrophage infiltrate in AIDS but is acid-fast.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Chronic inflammation: Whipple disease?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.