Tropheryma whipplei Infective Endocarditis as the Only Manifestation of Whipple's Disease

Abstract

Here we describe a case of infective endocarditis caused by Tropheryma whipplei in a patient with no other symptoms of Whipple's disease. The case was diagnosed using broad-range PCR and confirmed by specific PCRs. We review the cases of infective endocarditis presenting as the only manifestation of Whipple's disease reported in the literature. CASE REPORTA 51-year-old man was admitted to a hospital with a 1-month history of low-grade fever, dyspnea, and ankle edema. His medical history was unremarkable, with no previous heart valve damage. Physical examination revealed a temperature of 37.2°C and grade II/VI systolic and diastolic murmurs. Laboratory analysis revealed a high white blood count with left-side deviation. Electrocardiography showed that the patient was in sinus rhythm at 95 beats per minute. A transesophageal echocardiogram revealed two vegetations, one on the aortic valve, measuring 22 mm at the maximum point, and a smaller one on the anterior leaflet of the mitral valve.

Whipple's disease: misdiagnosed as sarcoidosis with further tricuspid valve endocarditis and pulmonary embolism - a case report

“…Usually, the mitral and aortic valves are diseased, and only in rare circumstances is the tricuspid valve affected 21. In many of these patients endocarditis is isolated, duodenal biopsy may be negative, and no other evidence of clinical Whipple’s disease is observed 22.…”

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

“…This form of endocarditis is an intracellular infection rather than a biofilm-like superficial cardiovalvular colonization with the bacterium. In most patients, there are no other manifestations of classic Whipple's disease (113,(149)(150)(151)(152), and clinical signs are similar to those of cardiac disease with negative blood cultures (113). In spite of the negative blood cultures, 80% of these patients displayed an increased C-reactive protein level, indicative of an infection and vegetations in 79% of cases (113).…”

Tropheryma whipplei—A rare and diagnostically challenging cause of culture-negative endocarditis

“…However, it can also present as chronic localized infection, such as endocarditis [5]. Although isolated Whipple's endocarditis without systemic involvement has been reported in the literature [6][7][8], this disease entity is rare. A recent literature review by McGee et al identified 44 publications totaling 169 patients with Whipple's endocarditis [9].…”

“…Diagnosis of Whipple's endocarditis is challenging due to negative blood cultures and the frequent absence of systemic signs of infection such as fever [5,6]. Tropheryma whipplei has an estimated 18-day generation time, which makes it one of the slowest growing human pathogens.…”