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Case Reports in Pathology
Volume 2019, Article ID 1509745, 4 pages
Case Report

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

1Department of Clinical Pathology, Promed SA, Medical Laboratory, Marly/Fribourg, Switzerland
2Department of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland

Correspondence should be addressed to Giacomo Puppa; hc.eguch@appup.omocaig

Received 25 February 2019; Revised 14 May 2019; Accepted 23 May 2019; Published 23 June 2019

Academic Editor: Janina Kulka

Copyright © 2019 Sabah Sid’Amar and Giacomo Puppa. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.