Tropheryma Whipplei endocarditis: Case report and literature review

Abstract

We describe a young man who initially presented with stroke and febrile illness. He was eventually diagnosed with Tropheryma whipplei endocarditis. This is a very rare condition and to the best of our knowledge, this is the first documented case of T. whipplei endocarditis in Australia and New Zealand regions. This report aims to increase awareness of clinicians of this very rare but potentially treatable condition. It is reasonable to exclude T. whipplei endocarditis when dealing with high-risk patients who are suspected for “culture-negative” endocarditis.

Treatment refractory arthritis and stroke – A case of infective endocarditis caused by Tropheryma whipplei

“…Infective Endocarditis presentation with stroke is an unusual presenting finding in patients with Whipple’s disease but has been described in previous reports [9] , [10] , [11] . Considering the burden of vegetations on his valves, the patient presented in this report likely had infective endocarditis for an extended period.…”

Whipple Disease Presenting as Isolated Transverse Myelitis with Permanent Neurological Damage in a Patient with Systemic Lupus Erythematosus: A Case Report of a Difficult Diagnosis with a Literature Review

“…Clinical picture: Asymptomatic TW carriers have been described [ 24 , 25 , 50 , 51 ], while WD is a heterogenic, multisystem disease that can present as [ 52 , 53 ] acute transient disease with fever and diarrhea [ 24 , 28 , 38 , 54 ]; localized infection, e.g., endocarditis or central nervous system disease [ 3 , 55 , 56 , 57 , 58 ]; or classic systemic disease characterized by a broad spectrum of clinical signs and symptoms, including weight loss, arthralgia, and diarrhea [ 2 ]. Sometimes these symptoms are misinterpreted, and patients are treated for rheumatologic diseases with immune suppressants that can accelerate the appearance of the systemic phase [ 51 ].…”

“…Hypothalamic involvement manifests as sleep disturbances like hypersomnia or severe insomnia [ 61 ], hyperphagia, polyuria, polydipsia, and libido disorders [ 62 ]. Other CNS manifestations are cerebellar ataxia [ 63 ], seizure and headache [ 12 , 64 ], pyramidal and extrapyramidal symptoms, supranuclear ophthalmoplegia [ 3 , 5 , 14 ], stroke [ 56 ], encephalitis and meningitis [ 14 , 59 , 65 ], and obstructive hydrocephalus [ 66 ]. Signs of sensory–motor myelopathy have been reported in rare cases of spinal cord involvement [ 3 , 6 , 8 , 9 , 13 ], while peripheral involvement is usually related to secondary malabsorption and nutritional deficits [ 5 ].…”

Seronegative Arthritis and Whipple Disease: Risk of Misdiagnosis in the Era of Biologic Agents

“…Fifty percent of patients receive immunosuppressive treatments which are responsible for a more rapid clinical progression (43%). Endocarditis is the second most frequent manifestation of T. whipplei [4], followed by neurologic symptoms. Other localized infections such as adenopathy, uveitis, pulmonary involvement, or frank arthritis are sporadic, but still may cause misdiagnoses.…”