CTICasesPulmonary, Mediastinal, and Bowel Whipple's Disease
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Imaging findings
Initial radiographs showed ill-defined consolidation/scarring in the right lower lobe. CT revealed mediastinal lymphadenopathy with slightly higher attenuation, extensive mosaic attenuation with lobular ground glass opacity, and subtle nodularity along the pleural surfaces and fissures. After antibiotic treatment, the lung ground glass opacity improved, and mediastinal nodes became smaller but persisted, with somewhat lower attenuation.
Key takeaways
Whipple's disease is a rare bacterial infection (Tropheryma whipplei) that can have multi-organ involvement, classically gastrointestinal but also cardiac, neurological, and pulmonary. Pulmonary involvement can mimic sarcoidosis, presenting with lymphadenopathy and interstitial changes (mosaic attenuation, ground glass, subtle nodularity). Diagnosis can be challenging and delayed, requiring specific PCR or special stains on biopsy. Patients may present with non-GI symptoms years before classic GI manifestations, as seen in this case. Whipple's disease typically responds to long-term antibiotics.
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