Lipophagic intestinal granulomatosis (Whipple's disease); clinical and pathologic study of thirty-four cases, with special reference to clinical diagnosis and pathogenesis.

Abstract

RECENT literature contains increasingly frequent reports of lipophagic intestinal granulomatosis following generally the descriptive pattern of Whipple's first case in 1907, which he called intestinal lipodystrophy. In this study of 34 collected cases the purpose is to establish the nature and frequency of the clinical features, in an attempt thereby to evolve a more clearcut pattern which may be of practical diagnostic value to the clinician. In addition, certain unusual pathologic characteristics, formerly considered coincidental, are now available in sufficient number to be significant. It will be indicated that these are indispensable in promoting a better understanding of pathogenesis and etiology. Also, a new case is presented, adding more data for analysis. Clinically, this disease is characterized initially by polyarthritis and later by postprandial abdominal pain, distention, diarrhea, wasting and death. The anatomic changes are represented by lipogranulomas in the mucosa of the small intestine and mesenteric lymph nodes, as