case_images: PMC10853719_01
case_images: Echo-Doppler ultrasound of the lower limbs. Heterogeneous luminal filling and lack of compressibility on the left (L) and right (R) popliteal veins, aspects compatible with bilateral deep vein thrombosis
case_images: cureus-0016-00000051991-i01.jpg
case_images: PMC10853719_01_cureus-0016-00000051991-i01.jpg
case_images: FIG1
case_images: An Echo-Doppler ultrasound of the lower limbs confirmed the diagnosis of bilateral popliteal venous thrombosis (Figure 1).
case_images: Anatomopathological study of lymph node . (A) Lymph node exhibiting distorted architecture characterized by a significant number of histiocytes, at times aggregated and forming non-necrotizing granulomas (black arrows). (B) Histochemical examination revealed threadlike structures, resembling bacilli, located intrahistiocytically, and these structures tested positive for PAS (Periodic Acid-Schiff) and PAS-diastase. No morphological or immunohistochemical evidence of neoplastic tissue was identified.. Images kindly provided by Dr. Joaquim Tinoco (Anatomical Pathology Service of Hospital Prof. Doutor Fernando Fonseca)
case_images: cureus-0016-00000051991-i02.jpg
case_images: PMC10853719_01_cureus-0016-00000051991-i02.jpg
case_images: FIG2
case_images: The presence of intrahistiocytic bacilli that reacted to periodic acid-Schiff staining raised the possibility of WD (Figure 2).
case_images: Histopathological study of small intestine biopsies. (A) Proximal intestine with relatively preserved crypt architecture, alongside mucosal expansion in certain villi due to the presence of xanthochromic macrophages (black arrows), H&E 4x. (B) In the histochemical analysis, intracytoplasmic bacilli that tested positive for PAS (Periodic Acid-Schiff) and PAS-D (Diastase) were identified. The Ziehl-Neelsen staining showed negative results, PAS-D 10x. Images kindly provided by Dr. Joaquim Tinoco (Anatomical Pathology Service of Hospital Prof. Doutor Fernando Fonseca)
case_images: cureus-0016-00000051991-i03.jpg
case_images: PMC10853719_01_cureus-0016-00000051991-i03.jpg
case_images: FIG3
case_images: The macroscopic examination did not reveal any abnormalities, but the histological findings from duodenal biopsies and the isolation of T. whipplei by polymerase chain reaction (PCR) confirmed the presence of WD (as shown in Figure 3).