Scalloping of the valvulae conniventes and mosaic mucosa in tropical sprue

Abstract

Tropical sprue is a chronic disorder acquired in endemic areas and is characterized by abnormalities of small bowel structure and function. 1 Malabsorption and resulting nutritional deficiencies can be ameliorated or cured with appropriate therapy of antibiotics and/or folic acid. Accurate diagnosis may be difficult since objective findings in this disorder are non-specific and symptoms may persist in expatriates following return to a temperate climate or may initially occur at any time up to 20 years after return. 2 Such non-specific findings include megaloblastic anemia, hypocalcemia, reduced serum levels of cholesterol and carotene, steatorrhea, and decreased D-xylose absorption. Barium studies may reveal non-specific coarsening of mucosal folds and intestinal dilation; flocculation and segmentation of barium are rarely seen today. Histologic findings in tropical sprue include broadening and shortening of villi, deepening of the crypts, and infiltration by chronic inflammatory cells. Recently, Jabbari et a1. described a distinctive scalloping of the valvulae conniventes and a mosaic appearing mucosa in a patient with celiac sprue. We report similar findings in a patient with tropical sprue, which suggests that these endoscopic findings may reflect total villous atrophy regardless of cause.