The diagnosis of tropical sprue in Puerto Rico has been defined in the studies of Suarez1 and Rodriguez-Molina.* Patients with this diagnosis have had macrocytic anemia and megaloblastic bone marrow changes associated with diarrhea, dyspepsia, weakness, and weight loss. They have been treated with liver extract, folic acid, and cyanocobalamin (vitamin B12), with excellent hematologic remission. An explanation for the disease has been attributed to nutritional deficiency, inasmuch as the majority of the patients have been indigent and have had poor dietary habits. The hematologic abnormalities have received major attention, and justly so, in an effort to rehabilitate the patients. However, such interest has emphasized the bone marrow dyspoiesis as the outstanding pathological physiology. This criterion is in striking contrast to sprue as observed in other tropical areas of the world. Anemia was not a prominent observation in the large series of sprue patients that were published
GARDNER FH. A Malabsorption Syndrome in Military Personnel in Puerto Rico. AMA Arch Intern Med. 1956;98(1):44–60. doi:10.1001/archinte.1956.00250250050008
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