Pulmonary manifestations of Whipple's disease.

Whipple's disease is a rare multisystem disorder which may affect the lungs and pleurae. Four men with Whipple's disease are described. All developed dyspnoea and pleuritic chest pain and three had a chronic cough. Lung function tests in three patients showed reduced lung volumes. Chest radiographic changes included pleural adhesions, small lung volumes and nodular shadowing. In three patients treatment of the Whipple's disease resulted in resulted in resolution of the disabling breathlessness, thus underlining the importance of recognising this feature of the disease. Although intestinal and joint manifestations of Whipple's disease are attributed to intracellular infection, the respiratory manifestations may be due to an inflammatory reaction to locally deposited immune complexes containing bacterial antigens.