, Volume 352, Issue 1, pp 34-42

Fine structure of the small bowel in dermatitis herpetiformis

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In seven patients with dermatitis herpetiformis, the intestinal structure was studied by means of the electron microscope. In 5 patients the absorptive epithelial cells showed variable modifications consisting of a dilatation of the rough endoplasmic reticulum and an overdevelopment of the smooth endoplasmic reticulum. The striated border microvilli were abnormal and presented edema and fusion with occasional disappearance, leaving clear areas on the intestinal surface. In two patients the ultrastructural study showed no modifications of the epithelial cells.

In all the cases examined the only constant finding consisted of a marked lymphocytic infiltration of the epithelium. The lymphocytes traversed through the basement membrane and were located in the intercellular space. The latter was frequently widened. The widening of the intercellular space was interpreted as secondary to the passage of the leukocytes through the epithelium.

On the basis of this study it was suggested that the lymphocytic infiltration could impair the absorptive ability of the intestinal epithelium, and that the electron microscopic study supports the opinion that some relationship exists between the intestinal changes in dermatitis herpetiformis and those present in non tropical sprue.