Abstract
Whipple’s disease is a rare infective condition, classically presenting with gastrointestinal manifestations. It is increasingly recognized as an important cause of culture-negative endocarditis. We present a case of Whipple’s endocarditis presenting with heart failure. A literature review identified 44 publications documenting 169 patients with Whipple’s endocarditis. The average age was 57.1 years. There is a clear sex predominance, with 85% of cases being male. Presenting symptoms were primarily articular involvement (52%) and heart failure (41%). In the majority of cases, the diagnosis was made on examination of valvular tissue. Preexisting valvular abnormalities were reported in 21%. The aortic valve was most commonly involved, and multiple valves were involved in 64% and 23% of cases, respectively. Antibiotic therapy was widely varied and included a ceftriaxone, trimethoprim, and sulfamethoxazole combination. The average follow-up was 20 months, and mortality was approximately 24%. Physician awareness is paramount in the diagnosis and management of this rare condition.
Highlights
Whipple’s disease is a rare infective condition, classically presenting with gastrointestinal manifestations, first described a little over a century ago
Arthralgia is the most common presenting complaint, which in our case was documented more than a year before the presentation that resulted in the diagnosis
Garcia-Alvarez et al described a large contemporary case series including 17 cases recruited by Spanish registry data for infective endocarditis [9]
Summary
The treating team commenced him on empirical antibiotic treatment including benzylpenicillin, flucloxacillin, and gentamicin, and he was subsequently referred to our institution for consideration of urgent aortic valve replacement. During his preoperative workup, further assessment for endocarditis occurred. A mechanical prosthesis was implanted, a 25-mm ATS Medical (Minneapolis, Minnesota) metallic valve, and further testing was performed to identify the etiology of infective endocarditis. He had a complicated surgical recovery with delirium, acute kidney injury, fluid overload, and a large pleural effusion. He was alive and living independently at home 18 months after discharge from the hospital
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