Whipple’s Disease Affecting Ileal Peyer’s Patches: The First Case Report

Abstract

Whipple’s disease is a rare chronic systemic bacterial infectious disease which can affect multiple organs, with a wide clinical spectrum encompassing many symptoms presenting in various forms and combinations. In the cases where the gastrointestinal tract is implicated, the more frequent localizations involve the small bowel, especially the duodenum. A case of a 67-year-old man who underwent clinical investigation after presenting with a progressive weight loss and showing a hypercapting right paracoeliac adenopathy at PET-CT scan is reported herein. A gastroscopy and a colonoscopy were done. The biopsies of the endoscopically normal ileal mucosa encompassed some submucosal Peyer’s patches. Histological examination of this lymphoid tissue revealed several foamy macrophages which turned out positive on periodic acid-Schiff special staining. Polymerase chain reaction of the microdissected lymph follicles allowed for confirming Whipple’s disease diagnosis. A targeted antibiotic treatment administrated to the patient led to a rapid clinical improvement. This finding of a previously unreported localization of infected macrophages in Whipple’s disease suggests that sampling the organized mucosal-submucosal lymphoid tissue may increase the diagnostic yield in endoscopic biopsies.

Enfermedad de Whipple: revisión sistemática de la literatura

“…En 1960, los hallazgos en la microscopia electrónica sumaron evidencia a dicha hipótesis y en 1990 se amplificó su ácido ribonucleico (ARN) por la técnica de PCR. Se logró su cultivo en 1997 (42) . La edad promedio de inicio de la enfermedad se relaciona con varios reportes de casos en los que se indica que la mayor prevalencia de la enfermedad está en un rango aproximado de 50 a 65 años; sin embargo, puede ocurrir en cualquier momento de la vida, por lo que existen reportes documentados desde una edad de 4 años hasta los 82 años .…”

Algorithmic Approach to Inflammatory Disorders of Ileum

“…The histopathology shows extensive infiltration of the lamina propria by the pink foamy macrophages with intense positive PAS staining along with lamina propria fat collection and epithelial vacuolization. The principal differential diagnoses include MAI infection (Ziehl-Neelsen positive) and muciphages that are faintly PAS (+) with no bacterial inclusions (33)(34)(35).…”