Whipple disease (gastrointestinal manifestations)
Gastrointestinal manifestations are a key component of Whipple disease. The gastrointestinal manifestations of t. whipplei are also known as intestinal lipodystrophy.
Extensive infiltration of lamina propria with large macrophages infected by intracellular Tropheryma whipplei causes marked swelling of intestinal villi and thickened irregular mucosal folds primarily in 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)
Reported radiologic features include:
- diffuse 1-2mm micronodules ("sand-like nodules") in the jejunum
- thickened mucosal folds: especially the jejunum
- small bowel calibre: normal or slightly dilated
- mesenteric lymphadenopathy: nodes of very low (near fat) density 2