Abstract
IntroductionThe main clinical manifestations of Whipple's disease are weight loss, arthropathy, diarrhea and abdominal pain. Cardiac involvement is frequently described. However, endocarditis is rare and is not usually the initial presentation of the disease. To the best of our knowledge, this is the first reported case of a patient with Tropheryma whipplei tricuspid endocarditis without any other valve involved and not presenting signs of arthralgia and abdominal involvement.Case presentationWe report a case of a 50-year-old Caucasian man with tricuspid endocarditis caused by Tropheryma whipplei, showing signs of severe shock and an absence of other more classic clinical signs of Whipple's disease, such as arthralgia, abdominal pain and diarrhea. Tropheryma whipplei was documented by polymerase chain reaction of the blood and pleural fluid. The infection was treated with a combined treatment of doxycycline, hydroxychloroquine and sulfamethoxazole-trimethoprim for one year.ConclusionTropheryma whipplei infectious endocarditis should always be considered when facing a blood-culture negative endocarditis particularly in right-sided valves. Although not standardized yet, treatment of Tropheryma whipplei endocarditis should probably include a bactericidal antibiotic (such as doxycycline) and should be given over a prolonged period of time (a minimum of one year).
Highlights
The main clinical manifestations of Whipple’s disease are weight loss, arthropathy, diarrhea and abdominal pain
Case presentation: We report a case of a 50-year-old Caucasian man with tricuspid endocarditis caused by Tropheryma whipplei, showing signs of severe shock and an absence of other more classic clinical signs of Whipple’s disease, such as arthralgia, abdominal pain and diarrhea
The Gram positive bacillus Tropheryma whippelii was first characterized by polymerase chain reaction (PCR) in the early 1990s [1], and renamed Tropheryma whipplei in 2001 after its first culture and characterization [2]
Summary
Tropheryma whipplei infectious endocarditis is a rare disease and tricuspid involvement is found even less often. This diagnosis should always be considered when facing a blood-culture negative endocarditis in right-sided endocarditis without risk factors. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Authors’ contributions VG was responsible for writing the manuscript and reviewing the literature. ZG, SJ and RR had significant roles in data gathering and were major contributors to the content of the manuscript. GG and DG had a significant role in data interpretation and provided significant revisions to the manuscript. All authors read and approved the final manuscript
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