Abdominal Pain, Cachexia and Anaemia

🗒️ Question

A 52 year old male presents with a 2 year history of chronic diarrhoea, significant weight loss and migratory polyarthritis. He reports abdominal pain, occasional fevers and night sweats. On physical examination, he appears cachectic, has hyperpigmentation of the skin and mild peripheral oedema. His medical history includes periodic episodes of lymphadenopathy and intermittent non-productive cough.

Blood results show anaemia, hypoalbuminaemia and elevated alkaline phosphatase. An upper endoscopy with biopsy reveals periodic acid-Schiff (PAS)-positive macrophages in the lamina propria.

What is the most likely diagnosis?

(A) Whipple’s disease
(B) Small intestine bacterial overgrowth (SIBO)
(C) Chronic pancreatitis
(D) Intestinal tuberculosis
(E) HIV enteropathy