Subcutaneous nodules in Whipple's disease

Background: Cutaneous findings other than hyperpigmentation are rare in Whi pple's disease. Case report: We present the case of a 59-year-old man previously diagnosed with Whipple's disease by duodenal biopsy, who developed red-brown, painful , subcutaneous nodules on the buttocks, thighs, arms and legs. Biopsy of th ese nodules showed a septal panniculitis and foamy macrophages containing P AS-positive, diastase resistant intracytoplasmic material, characteristic o f Whipple's disease and similar to that observed in the duodenal biopsy. Ul trastructurally, this material in the histiocytes corresponded to degenerat ed bacilli. Conclusions: This is the fourth documented case of subcutaneous involvement by Whipple's disease. One should consider the possibility of Whipple's dis ease in any patient who presents with symptoms compatible with that conditi on who demonstrates septal panniculitis with a large amount of foamy histio cytes.