Intestinal Lipodystrophy (Whipple's Disease): Demonstration of Anatomic Alteration Before Onset of Symptoms

A CHARACTERISTIC feature of the clinical picture of many cases of intestinal lipodystrophy (Whipple's disease) is the presence of symptoms long before diagnosis._1-3 Arthralgias, in particular, have been noted for periods of 1 to 15 years before intestinal problems become manifest, and these joint difficulties are often associated with asthenia, weight loss, and pigmentation. The diagnosis, however, is rarely made in the absence of gastrointestinal dysfunction and then finally by histological examination of the intestine or peripheral lymph node.₄ Previously, therefore, it has been impossible to determine if these preexisting symptoms were associated with morphologic alterations and, if they were, to explain the delayed presentation of the intestinal disorder. That the disease may be very slowly progressive is of increasing significance in view of a possible infectious etiology and the reversibility of the bowel disorder after antibiotic treatment._5-7 In this report the presence of full-blown lesions of.