Whipple's disease: a case with circulating immune complexes

A patient with Whipple's disease was studied for 56 wk from diagnosis, during which time he received continuous antibiotic therapy. Intramucosal bacillary bodies detected by electron microscopy disappeared within 12 wk and a threefold fall in antibody titer to Hemophilus influenza type B bacillus occurred during this period. Circulating immune complexes of IgG class were consistently detected during the first 28 wk of treatment but not subsequently. IgM class immune complexes were detected at a time when mucosal recovery had occurred and when IgG complexes were no longer detectable. A further rise of IgM immune complexes could be induced by enteric challenge with bovine serum albumin in our patient but not in control subjects. The detection of serum immune complexes in Whipple's disease may reflect the entry of foreign antigen through intestinal mucosa. These observations also support the possibility of an underlying defect of antigen exclusion in this disorder, which persists despite apparent mucosal recovery.