Clinical and Biochemical Syndrome in Lymphadenoma

Abstract

Pathologist, Hospital for Tropical Diseases (WITH SPECIAL PLATE) From time to time during the past six years adult patients have been admitted to the Hospital for Tropical Diseases who present what for teaching purposes may be described as the " sprue abdomen," yet subsequent investigation has revealed another cause. There is a history of diarrhoea or looseness of the bowels associated with the passage of large, pale, offensive, fatty, and gaseous stools. Wasting is marked. The skin is harsh and dry, and sometimes shows brownish-yellow discoloration. The abdominal muscles are atrophied, and not infrequently a " doughy feeling" is imparted to the examining fingers. Abdominal distension may be marked. Decreased physical reserve and hypotension are always present; anaemia, muscular cramps, tetany, and lingual features may occur. The similarity to. sprue, however, does not end here, for laboratory investigation generally reveals a common biochemical background consisting of: (1) a high percentage of faecal fat, which is generally adequately split; (2) a flat type of glucose tolerance curve, or one showing a delayed maximal rise; and (3) decreased serum calcium associated with normal or low blood phosphorus. These features are not invariably present in every case. The bilirubin content of the plasma is normal or only slightly increased. Haematological investigations may reveal a typical megalocytic anaemia with hyperchromia, ortho-chromia, or even hypochromia. In other instances the anaemia may be normocytic with orthochromia or micro-cytic with hypochromia.