Periodic acid-Schiff-negative granulomatous lymphadenopathy in patients with Whipple's disease. Localization of the Whipple bacillus to noncaseating granulomas by electron microscopy

Am J Med. 1987 Jul;83(1):165-70. doi: 10.1016/0002-9343(87)90514-6.


The diagnosis of Whipple's disease in a 58-year-old man was based on the finding of periodic acid-Schiff (PAS)-positive foamy macrophages on duodenal biopsy and demonstration of the typical bacilliform bodies by electron microscopy. The patient also had generalized peripheral lymphadenopathy with lymph node biopsy showing PAS-negative noncaseating granulomas. Electron microscopic examination of the lymph node specimen demonstrated a small number of typical bacilliform bodies with localization specifically to the granulomas in the lymph node. This finding of bacilliform bodies within PAS-negative noncaseating granulomas has not been reported previously. Localization of the Whipple bacillus specifically to noncaseating granulomas suggests that some patients with the disease may manifest a delayed hypersensitivity reaction to the bacillus.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biopsy
  • Bone Marrow / metabolism
  • Bone Marrow / ultrastructure
  • Duodenum / metabolism
  • Duodenum / ultrastructure
  • Granuloma / diagnosis*
  • Granuloma / metabolism
  • Granuloma / pathology
  • Humans
  • Lymph Nodes / metabolism
  • Lymph Nodes / ultrastructure
  • Lymphatic Diseases / diagnosis*
  • Lymphatic Diseases / metabolism
  • Lymphatic Diseases / pathology
  • Macrophages / metabolism
  • Macrophages / ultrastructure
  • Male
  • Microscopy, Electron
  • Middle Aged
  • Periodic Acid-Schiff Reaction
  • Whipple Disease / diagnosis*
  • Whipple Disease / metabolism
  • Whipple Disease / pathology