Table of Contents
Definition / general | Case reports | Treatment | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Electron microscopy description | Electron microscopy images | Molecular / cytogenetics description | Differential diagnosisCite this page: DePond WD. Whipple disease. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphnodeswhipple.html. Accessed January 17th, 2021.
Definition / general
- Rare; due to infection by Tropheryma whipplei, present in soil and sewage but not animals
- Typically affects farmers and outdoor workers
- Symptoms include diarrhea, malabsorption, weight loss, fever, arthralgias; also occasional CNS and cardiac involvement
- May cause marked enlargement of mesenteric and periaortic lymph nodes; enlargement of peripheral lymph nodes may occur early
- Diagnosis requires massive involvement of node plus intense PAS+ staining (small aggregates of PAS+ macrophages are nonspecific) or PCR
- Gram stain: gram+ bacteria
Case reports
- 55 year old woman with mesenteric lymphadenopathy and a monoclonal B cell proliferation (Arch Pathol Lab Med 2003;127:1619)
Treatment
- IV penicillin and streptomycin or third generalization cephalosporin for 10 - 14 days, plus cotrimoxazone for 1 year
Microscopic (histologic) description
- Nodal architecture obscured by ill defined lipogranulomas
- Involvement of sinuses by macrophages with foamy cytoplasm
Microscopic (histologic) images
Contributed by Dr. Mark R. Wick
Various images
PAS stain
Warthin-Starry stain
Positive stains
- PAS+ diastase resistant bacilli within histiocytes
- Immunostains for bacteria (Am J Clin Pathol 2002;118:742)
Negative stains
Electron microscopy description
- Rod-like organisms
Electron microscopy images
Images hosted on other servers:
Trilaminar cell wall
Molecular / cytogenetics description
- PCR to confirm diagnosis (Am J Clin Pathol 2001;116:898, difficult to culture)
Differential diagnosis
