Matuchansky C, Touchard G, Babin P, Lemaire M, Cogné M, Preud'homme J L
Department of Gastroenterology, University Hospital, Poitiers, France.
Gastroenterology. 1988 Aug;95(2):470-7. doi: 10.1016/0016-5085(88)90506-9.
In two white adults born, raised, and living in central France and presenting with long-lasting malabsorption, massive and diffuse lymphoid infiltrate of the lamina propria associated with crypt scarcity was found along the whole small bowel. It was mostly composed of mature lymphocytes, focally mixed with plasma cells and reactive germinal centers. There was no evidence of celiac disease, systemic or intestinal immune deficiency or alpha-chain disease, overt lymphoid malignancy, or stagnant-loop syndrome. By immunofluorescence the infiltrate was constituted in 1 case of polyclonal B cells and, in the other, of a large majority of T11, T8, T10, and class II-positive T cells associated with a population of monotypic B cells. A gluten-free diet and parenteral nutrition proved ineffective. A dramatic and protracted clinical response was observed in both patients after the onset of oral tetracycline therapy, and still persists after 8 and 5.5 yr, respectively, together with morphologically unchanged small bowel infiltrate. These cases may be the equivalents, in people from Western developed countries, of the predominantly lymphocytic variety of the immunoproliferative small intestinal disease described in people from developing countries.
两名在法国中部出生、成长并生活的白人成年人，出现了长期吸收不良的症状，在整个小肠中发现固有层有大量弥漫性淋巴细胞浸润，并伴有隐窝稀少。浸润主要由成熟淋巴细胞组成，局部混有浆细胞和反应性生发中心。没有乳糜泻、全身性或肠道免疫缺陷或α链病、明显的淋巴恶性肿瘤或肠袢综合征的证据。通过免疫荧光检查，1例浸润由多克隆B细胞构成，另一例则以大量T11、T8、T10和II类阳性T细胞为主，伴有一群单型B细胞。无谷蛋白饮食和肠外营养均无效。口服四环素治疗开始后，两名患者均出现了显著且持久的临床反应，分别在8年和5.5年后仍持续存在，同时小肠浸润在形态上没有变化。这些病例可能相当于西方发达国家人群中，与发展中国家人群中所描述的免疫增殖性小肠疾病的主要淋巴细胞类型相当的情况。
