WHIPPLES-DISEASE - A SINGLE OR MULTIPLE O RIGIN

After having been considered as an essentially digestive disease, Whip ple's disease has appeared more and more to be a multivisceral disease with two main characteristics: on one hand Whipple's disease yields a diffuse infiltration of tissues by abnormal macrophages without any o ther inflammatory reaction ; on the other hand, aspects of microbial i nvasion by intra or extracellular unique rod-shaped Gram+ bacteria are found. This unusual pathological complex has alternatively been consi dered as suggestive of an immunological defect or as a very unusual ty pe of bacterial infection. Though recent studies support the hypothesi s of a primary microbial infection due to a hitherto undescribed bacte rium (Tropheryma whippelii) or more or less related bacteria belonging to the actinomycetes family, they do not totally exclude a primary or acquired impairment of antigen processing by macrophages. Speculation s about this fascinating pathophysiological model and about its optima l therapeutic modalities are not likely to reach a conclusion in the n ear future.