Summary
An unusual course of Whipple's disease is reported. All clinical symptoms disappear with antibiotic therapy. Multiple control biopsies show a high grade and progressive collagen formation of the stratum proprium mucosae which takes places especially in the pericellular region and near the epithelial basal membrane. The number of lymphocytes, plasma cells and interepithelial lymphoid round cells is increased considerably.
Immunologically the serum complement (C3-fraction) is decreased. Immunohistologically subepithelially and interepithelialy situated cells are found after incubation with the patients serum showing a cellular-cytoplasmatic fluorescence with anti-complement. These findings are discussed as a hyperreactive mechanism possibly leading to induction of a cellular immune process.
Zusammenfassung
Berichtet wird über den ungewöhnlichen Verlauf eines Morbus Whipple. Unter antibiotischer Therapie tritt klinisch eine völlige Beschwerdefreiheit ein. Mehrfache Kontrollbiopsien zeigen eine hochgradige und progrediente Kollagenisierung des Stratum proprium mucosae, die besonders auch pericellulär und im Bereich der epithelialen Basalmembran entwickelt ist. Lymphocyten, Plasmazellen und interepitheliale lymphoide Rundzellen sind stark vermehrt. Immunologisch ist Serum-Komplement (C3-Fraktion) erniedrigt. Immunhistologisch findet sich nach Inkubation mit Patientenserum eine cellulär-cytoplasmatische Fluorescenz mit Anti-Komplement von subepithelial und interepithelial gelegenen Zellen. Die Befunde werden im Sinne eines hyperreaktiven Vorganges, der möglicherweise zur Induktion eines cellulären Immunmechanismus geführt hat, diskutiert.
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Literatur
Bullock, W. E., Fasal, P.: Studies of immune mechanisms in leprosy. III. Role of cellular and humoral factors in impairment of the in vitro immune response. J. Immunol.106, 888 (1971)
Caroli, J., Julien, C.: Conception etiologique nouvelle de la maladie de Whipple. Acta gastro-ent. belg.27, 488 (1964)
Doe, W. F., Booth, C. C., Brown, D. L.: Evidence for complement-binding immune complexes in adult coeliac disease, Crohn's disease, and ulcerative colitis. Lancet1973 I, 402
Douglas, A. P., Crabbe, P. A., Hobbs, J. R.: Immunochemical studies of the serum, intestinal secretions and intestinal mucosa in patients with adult coeliac disease and other forms of coeliac syndrome. Gastroenterology59, 414 (1970)
Ginsberg, A. L.: Alterations in immunologic mechanisms in diseases of the gastrointestinal tract. Dig. Dis.16, 61 (1971)
Götze, O., Müller-Eberhard, H. J.: The C3-activator system: an alternate pathway of complement activation. J. exp. Med.134, 90 (1971)
Green, F. H. Y., Fox, H.: An immunofluorescent study of the distribution of immunoglobulin-containing cells in the normal and the inflamed human gall bladder. Gut13, 379 (1972)
Groll, A., Valberg, L. S., Simon, J. B., Eidinger, D., Wilson, B., Forsdyke, D. R.: Immunological defect in Whipple's disease. Gastroenterology63, 943 (1972)
Haubrich, W. S., Watson, J. H. L., Sieracki, J. C.: Unique morphologic features of Whipple's disease: A study by light and electron microscopy. Gastroenterology39, 454 (1960)
Kirsner, J. B.: Ulcerative colitis 1970—recent developments. Scand. 7, Gastroenterol. 5, Suppl. 6, 63 (1970)
Levene, G. M., Turk, J. L., Wright, D. J. M.: Reduced lymphocyte transformation due to a plasma factor in patients with active syphilis. Lancet1969 II, 246
Maizel, H., Ruffin, J. M., Dobbins, W. O.: Whipple's disease: a review of 19 Patients from one hospital and a review of the literature since 1950. Medicine (Baltimore)49, 175 (1970)
Martin, F. F., Vilseck, J., Dobbins, W. O., Buckley, C. E., Tyor, M. P.: Immunological alteration in patients with treated Whipple's disease. Gastroenterology63, 6 (1972)
Monteiro, E., Fossey, J., Shiner, M.: Antibacterial antibodies in rectal and colonic mucosa in ulcerative colitis. Lancet1971 I, 249
Newberry, W. M., Chandler, J., Chin, T. D. Y.: Depressed lymphocyte transformation in chronic histoplasmosis. J. Immunol.100, 436 (1968)
Ruffin, J. M., Roufail, W. M.: Whipple disease: Evolution of current concepts. Amer. J. dig. Dis., N.S.11, 580 (1966)
Shiner, M., Ballard, J.: Antigen-Antibody reactions in jejunal mucosa in childhood coeliac disease after gluten challenge. Lancet1972 I, 1202
Shiner, M., Shmerling, D. H.: The immunpathology of coeliac disease. Digestion5, 69 (1972)
Sieracki, J. C.: Whipple's disease-observations on systemic involvement 1. Cytologic observations. Arch. Path.66, 464 (1958)
Sieracki, J. C., Fine, G.: Whipple's disease-observations on systemic involvement. 2. Gross and histologic observations. Arch. Path.67, 81 (1959)
Spitzer, R. E., Valotta, E. H., Forristal, J., Sudora, E., Spitzel, A., Davis, N. C., West, C. D.: Serum C3 lytic system in patients with glomerulonephritis. Science164, 436 (1969)
Trier, J. S., Phelps, P. C., Eidelman, S., Rubin, C. E.: Whipple's disease: light and electron microscope correlation of jejunal mucosal histology with antibiotic treatment and clinical status. Gastroenterology48, 684 (1965)
Turk, J. L., Waters, M. F. R.: Cell-mediated immunity in patients with leprosy. Lancet1969 II, 243
Weller, Th. H., Coons, A. H.: Fluorescent antibody studies with agents of varicella and herpes zoster propagated in vitro. Proc. Soc. exp. Biol. (N.Y.)86, 789 (1954)
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Buchholz, K., Maintz, J. & Otto, H.F. Klinisch-immunologische und elektronenmikroskopische Untersuchungen bei Morbus Whipple. Klin Wochenschr 52, 672–677 (1974). https://doi.org/10.1007/BF01468478
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DOI: https://doi.org/10.1007/BF01468478