Massive macrophage lipid accumulation presenting as hepatosplenomegaly and lymphadenopathy associated with long-term total parenteral nutrition therapy for short bowel syndrome.
We present a unique case of massive splenomegaly, hepatomegaly, and lymphadenopathy caused by lipid-laden macrophages in a 50 year old white female with short-bowel syndrome treated with long-term total parenteral nutrition. Using transmission electron microscopy and special stains we were able to show that the total parenteral nutrition lipid component was composed of lipid droplets and micelles morphologically identical to those found in lipid-laden macrophages which had accumulated in the patient's reticuloendothelial system leading to massive splenomegaly, hepatomegaly (without evidence of steatosis) and lymphadenopathy. While this phenomenon has been reported in animal models, no human cases have been previously reported.
Perez-Jaffe
L A
LA
Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA.
Furth
E E
EE
Minda
J M
JM
Unger
L D
LD
Lawton
T J
TJ
D005217:Fat Emulsions, Intravenous / Q000009:adverse effects*; D005260:Female; D005487:Foam Cells / Q000378:metabolism / Q000473:pathology*; D006529:Hepatomegaly / Q000209:etiology* / Q000473:pathology; D006801:Humans; D050356:Lipid Metabolism; D008206:Lymphatic Diseases / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D012778:Short Bowel Syndrome / Q000628:therapy*; D013163:Splenomegaly / Q000209:etiology* / Q000473:pathology
D005217:Fat Emulsions, Intravenous