Small intestine & ampulla

Infectious disorders

Whipple disease

Topic Completed: 1 August 2012

Minor changes: 18 October 2021

Copyright: 2003-2021,, Inc.

PubMed Search: Whipple disease[TIAB] small bowel

Hanni Gulwani, M.B.B.S.
Page views in 2020: 11,650
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Cite this page: Gulwani H. Whipple disease. website. Accessed October 21st, 2021.
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

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

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Pathophysiology of Whipple disease

  • PCR, immunohistochemistry, PAS stain (PAS+ diastase resistant)
Case reports
  • 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

  • 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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Contributed by Derek Mathis, M.D. and Rosemarie Rodriguez, M.D.

Various images

PASD images

Case #303 (case #1)

H&E and PAS

Case #303 (case #2)


PAS stain

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

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52 year old man

Whipple disease, duodenum

T. whipplei bacteria

Bacterium (arrowhead)

Differential diagnosis
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