Tropheryma whipplei bivalvular endocarditis and polyarthralgia: a case report

Abstract

IntroductionTropheryma whipplei infection should be considered in patients with suspected infective endocarditis with negative blood cultures. The case (i) shows how previous symptoms can contribute to the diagnosis of this illness, and (ii) elucidates current recommended diagnostic and therapeutic approaches to Whipple's disease.Case presentationA 71-year-old Swiss man with a past history of 2 years of diffuse arthralgia was admitted for a possible endocarditis with severe aortic and mitral regurgitation. Serial blood cultures were negative. Our patient underwent replacement of his aortic and mitral valve by biological prostheses. T. whipplei was documented by polymerase chain reactions on both removed valves and on stools, as well as by valve histology. A combination of hydroxychloroquine and doxycycline was initiated as lifetime treatment followed by the complete disappearance of his arthralgia.ConclusionsThis case report underlines the importance of considering T. whipplei as a possible causal etiology of blood culture-negative endocarditis. Lifelong antibiotic treatment should be considered for this pathogen (i) due to the significant rate of relapses, and (ii) to the risk of reinfection with another strain since these patients likely have some genetic predisposition.

Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections

“…It is important that clinicians are aware of this, because up to 50% of the patients with classic Whipple's disease were initially misdiagnosed and given antirheumatic agents like disease-modifying antirheumatic drugs (DMARDs), anti-necrosis factor alpha, glucocorticoids, or drugs that can enhance the spread of the infection and thus may have fatal consequences (102,111). In retrospect, physicians should consider occult T. whipplei infections in patients treated for unrelated bacterial infections showing a surprising decrease in their previously unexplained arthralgia (112,113).…”

A rare case of Whipple’s disease with endocarditis in a patient with dextrocardia

“…10 Some other studies have proposed 24 months of treatment and consideration for lifelong suppression. 14 As our patient responded well to the treatment of intravenous ceftriaxone and ampicillin–sulbactam, this regimen was continued for 6 weeks followed by 12 months therapy with oral trimethoprim-sulfamethazine.…”

“…T. whipplei is susceptible in vitro to doxycycline, sulfamethoxazole, penicillin, third-generation cephalosporins, carbapenems, aminoglycosides, and chloramphenicol. 13,14 Some studies have recommended 2 weeks of intravenous ceftriaxone followed by oral trimethoprim-sulfamethazine for 12 months. 10 Some other studies have proposed 24 months of treatment and consideration for lifelong suppression.…”

Tropheryma Whipplei endocarditis: Case report and literature review

“…[5] It has been proposed that patients be monitored for early relapse or reinfection with PCR on saliva and stool 3 and 6 months after commencement of treatment and annually thereafter. [6]…”