[Whipple's disease. Involvement of the small intestine with submucosal presentation]

An unusual case of Whipple's disease is described; the involvement was restricted to the sub-mucosa of the large and small intestine, but the mucosa was spared. The involvement was characterized by the presence of large eosinophilic PAS positive histiocytic cells in the sub-mucosa. A Ziehl-Neelsen stain allowed to rule out an atypical mycobacterial infection. In the axillary lymph node removed previously, a retrospective survey demonstrated the presence of large histiocytic cells containing granular PAS positive material. The diagnosis of Whipple's disease of the large and small intestine with lymph node involvement was confirmed by the response to therapy followed by a new biopsy control. It appears from our observation that in Whipple's disease, an attentive examination of the sub-mucosal tissue may allow to discover more cases of this condition, even when the mucosa appears normal.