IDIOPATHIC STEATORRHEA: WITH REPORT OF A CASE OF WHIPPLE'S DISEASE

Abstract

The clinical course and pathologic findings of a case of lipophagic granulomatosis (Whipple''s disease) is presented. The important gross pathologic findings were the shaggy exudates on the surfaces of the liver, spleen, peritoneum, pericardium and pleura; the marked thickening of the wall of the small intestine; and the markedly enlarged mesenteric lymph nodes. Microscopically, the shaggy projections were shown to be dilated lymphatic channels. The intestinal villi were three to four times wider and longer than normal. Large irregular vacuoles of various sizes were scattered throughout the villi. The architecture of the lymph nodes was replaced by many vacuoles, giving it a swiss-cheese pattern. The author suggests that the pathologic physiology in Whipple''s disease differs only in degree but not in kind from that obtained in any other disease in which there is sufficient obstruction between the villi and the thoracic duct, be that disease Hodgkin''s, tuberculosis or regional ileitis. The reason for the rarity of the syndrome is ascribed to the ease with which lymph channels produce new anastomoses with veins.