Small bowel (small intestine)
Infectious disorders
Whipple disease

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 15 February 2018, last major update August 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Whipple disease[TIAB] small bowel

Cite this page: Gulwani, H. Whipple disease. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/smallbowelwhipple.html. Accessed July 18th, 2018.
Definition / general
  • Rare systemic infection due to Tropheryma whippelii, a gram positive intracellular actinomycete (World J Gastroenterol 2009;15:2078)
  • Usually affects proximal intestine, mesenteric lymph nodes
  • Also called intestinal lipodystrophy
  • Usually white males ages 30 - 49 years

Symptoms:
  • Malabsorption with diarrhea, weight loss, abdominal pain
  • Occasionally polyarthritis, CNS complaints, lymphadenopathy, hyperpigmentation
  • Cardiac involvement less common
  • Fatal without antibiotics
Diagrams / tables

Images hosted on other servers:

Pathophysiology of Whipple disease

Diagnosis
  • PCR, immunohistochemistry, PAS stain (PAS+ diastase resistant)
Case reports
Treatment
  • Antibiotics
  • Relapses are common
Gross description
  • Shaggy mucosa, edematous bowel wall
Microscopic (histologic) description
  • Distended macrophages in lamina propria containing PAS+ (diastase resistant) granules and rod shaped bacilli by EM
  • Dilated lymphatics or fat vacuoles
  • Often multinucleated giant cells; rarely epithelioid granulomas in minority
  • In mesentery or retroperitoneal nodes, resembles lipogranulomatous inflammation with round empty spaces

Note:
  • After treatment, macrophages decrease in lamina propria but remain present elsewhere for years; cytoplasmic inclusions become tissue paper-like with PAS stain, resembling Gaucher cells
Microscopic (histologic) images

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Images hosted on PathOut server:

Images contributed by Drs. Derek Mathis and Rosemarie Rodriguez, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas:


Various images


PASD images



Case of the Week #303 (case #1):

H&E


PAS stain



Case of the Week #303 (case #2):


H&E


PAS stain

Positive stains
Electron microscopy description
  • Rod shaped bacteria
Electron microscopy images

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52 year old man

Differential diagnosis