Table 5.

Comparision of histopathology (PAS-positive inclusions in macrophages) and PCRa for patients with suspected or proven Whipple's disease

Clinical manifestationsType of specimenResult byReference(s)
PAS stainingPCR amplification
Spondylodiscitis, occasional fever, no diarrhea Terminal ileum ++ 5
Duodenum +
Colon +
Lumbar spine +
Blurred vision, parkinsonian syndrome Small bowel + 8
Neck pain and limb paraesthesia Cord biopsy +NDb 30
Jejunal biopsy +
Oculomotoric disorders, nystagmus, fever, weight lossCerebrospinal fluid + 31, 36
Suspected neurological Whipple's disease Intestine + 36
Weight loss, abdominal lymphadenopathy, fever, arthritisDuodenum c ND  67
Joint fluid ND +
Endocarditis Aortic valve+ + 79
Duodenum +
Relapsing oligoarthritis Duodenum + 83
Arthralgias, chronic colitis Duodenum + 83
Ileum +ND 
Arthritis Joint fluid + 83
Gaze, cognitive changes, depression Duodenum + 107
Hepatosplenomegaly, episodic fever, granulomatous lymphadenopathy, no gastroinestinal symptoms Lymph nodes +ND  129
Duodenum +
Spleen ++
Blood ND +
Arthropathy, episodic fever, hepatosplenomegaly, granulomatous lymphadenopathy, episodes of intestinal obstruction Synovium ND  129
Duodenum +
Blood ND +
Fever, night sweats, para-aortic lymphadenopathy, no gastrointestinal symptoms Lymph nodes + 129
Duodenum +
Blood ND +
Spastic tetraparesis, no gastrointestinal symptoms Spinal cord + ND  129
Duodenum +
Anorexia, arthritis, night sweats, lymphadenopathy Duodenum+ + 133
Antrum +
BloodND +
Fever, neurological symptoms, hyperpigmentationMesenteric lymph node + ND  133
Duodenum+
Weight loss, diarrhea, cachexia Duodenum ++ 133
Antrum + +
Stomach +
Blood ND +
Weight loss, diarrhea, arthralgias, increased skin pigmentation Duodenum + + 143
Stomach +
Liver +
Osteoporosis, anemia, poor appetite, occasional diarrhea, steatorrhea (diagnosed as sprue) Small bowel?d + 150
Prolonged episodic diarrhea (diagnosed as sprue) Small bowel + 150
Fever, enlarged paraortic lymph nodes Small bowel + 150
Lymph nodes ?  +
Diarrhea, weight lossSmall bowel + 150
Bilateral uveitis, arthritis, weight loss Vitreous fluid + + 155
Duodenum+
  • a Different PCR methods were used.

  • b ND, not done.

  • c Positive by electron microscopy.

  • d ?, suspicious histologic findings.