[Immunological profile of Whipple's disease evolving over a period of 17 years]

This report describes an immunological study made on a 58 years old patient with a Whipple disease diagnosed in 1969 and treated with different antibiotics. All attempts to stop the antibiotherapy resulted in reappearance of clinical symptoms. Further, this patient suffered anguillulosis infection in 1954 and this persists despite thiabendazole therapy, as shown by periodical creeping lunear dermatitis (larva currens). Laboratory investigations displayed low IgM levels and lack of cutaneous reactivity to conventional antigenic challenge. In vitro studies on granulocyte and monocyte phagocytic activity did not display any clearcut deficiency. Finally, this patient displayed peripheral lymphopenia and decrease of the T4+ (CD4) lymphocyte subpopulation. The proliferative response of lymphocytes to phytohemagglutinin stimulation (a cellular T-cell function) was drastically decreased in assays performed during the 16 month duration of patient's exploration. This proliferative defect seems to be due to increased PGE2 release (a 3-5 fold increase was demonstrated), resulting in inhibition of interleukin 2 (IL2) synthesis and activity. Further, patient's lymphocyte normally expressed IL2 receptor. When the B lymphocyte dependent humoral response was assayed, normal B lymphocyte differentiation into plasmocytes was found. However the pokeweed mitogen induced proliferative response of B lymphocyte displayed major decrease in four sequential tests. This might be due to a lack of B cell growth factor (BCGF) activity, since this interleukin involved in T lymphocyte, B lymphocyte cooperation was not found in supernatants of patient's cell. Further, interleukin 1 (involved in macrophage lymphocyte cooperation) was normally produced. In conclusion, no deficiency of in vitro phagocytose was demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)