Whipple disease (gastrointestinal manifestations)

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Gastrointestinal manifestations are a key component of Whipple disease.  The gastrointestinal manifestations of Tropheryma whipplei are also known as intestinal lipodystrophy.

Pathology

Extensive infiltration of the lamina propria with large macrophages infected by intracellular T. whipplei causes marked swelling of intestinal villi and thickened irregular mucosal folds primarily in the duodenum and proximal jejunum. When they become large enough to be macroscopically visible, they may appear as innumerable small filling defects superimposed on irregularly thickened folds (sand-like nodules)

Radiographic features

Reported radiologic features include:

  • diffuse 1-2 mm micronodules ("sand-like nodules") in the jejunum
  • thickened mucosal folds: especially the jejunum
  • small bowel caliber: normal or slightly dilated
  • mesenteric lymphadenopathy: nodes of very low (near fat) density