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Specific cutaneous involvement in Whipple disease.

Laia Canal1, Diana de la Fuente, Jesús Rodriguez-Moreno

  • 1Departments of *Dermatology, †Rheumatology, and ‡Pathology, Hospital Universitari de Bellvitge, Barcelona, Spain.

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Summary

Cutaneous lesions in Whipple disease (WD) are rare but can show specific findings. This case highlights dermal lesions with PAS-positive macrophages and confirmed Tropheryma whipplei DNA.

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Area of Science:

  • Dermatology
  • Infectious Diseases
  • Pathology

Background:

  • Cutaneous manifestations of Whipple disease (WD) are uncommon and typically nonspecific.
  • Specific skin lesions in WD, when present, usually affect the subcutaneous fat.

Observation:

  • A patient with diagnosed Whipple disease developed multiple small subcutaneous nodules following antibiotic therapy.
  • Skin biopsy revealed septal panniculitis and a mild granulomatous dermal reaction.

Findings:

  • PAS-positive macrophages, characteristic of WD, were observed in the dermal biopsy.
  • Polymerase chain reaction (PCR) confirmed the presence of Tropheryma whipplei DNA in the cutaneous sample.

Implications:

  • Dermatopathologists should consider WD in the differential diagnosis of dermal and subcutaneous lesions.
  • Specific histological and molecular findings can aid in diagnosing cutaneous Whipple disease, even after treatment initiation.