Clinical syndrome resembling tropical sprue in lifelong residents of temperate zone

Two lifelong residents of the Philadelphia area, with malabsorption of an unclassified type suggestive of tropical sprue, are described. They manifested steatorrhea, a sprue pattern on X-ray examination of the small bowel, compatible small-bowel biopsy findings and bacterial cultures showing coliform growth in the upper small intestine. Other causes of malabsorption were excluded by exhaustive testing. The 1 patient, so tested, manifestedd-xylose malabsorption, while the other showed malabsorption of vitamin B12. Both patients presented with features clearly different from those of celiac sprue or the blind loop syndrome in its widest interpretation. While the evidence is not entirely conclusive, the data suggest that these patients suffered from a malabsorptive syndrome bearing close resemblance to the syndrome of tropical sprue, and that “tropical sprue” may be encountered, though rarely, in lifelong residents of the United States.