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

Abstract

We report a case of an elderly Caucasian male with past medical history of dextrocardia with situs inversus totalis, polymyalgia rheumatica, history of cryptogenic stroke, and severe mitral regurgitation with mitral valve prolapse, who presented with acute heart failure symptoms, including severe dyspnea on exertion and worsening lower extremity edema in the setting of immunosuppression with steroids for a year-old diagnosis of polymyalgia rheumatica. One month prior to this presentation, the patient suffered a transient ischemic attack and during the workup, his transthoracic echocardiography showed myxomatous degeneration of posterior mitral leaflet, partially flail, with severe mitral regurgitation, which required mitral valve replacement. Genome sequencing of mitral valve anterior leaflet pathology detected Tropheryma whipplei as a causal agent of culture-negative endocarditis. The patient was treated with 6 weeks of ceftriaxone and ampicillin–sulbactam and further continued trimethoprim–sulfamethoxazole for 1 year. He continued antibiotic treatment with resolution of shortness of breath along with arthralgia.

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.…”

The clinical value of valve metagenomic next-generation sequencing when applied to the etiological diagnosis of infective endocarditis

“…Fastidious or non-culturable microbes are important causes of BCNE, such as HACEK group bacteria (5), Abiotrophia spp., Bartonella spp. (6), Tropheryma whipplei (7), Coxiella burnetii, Mycoplasma spp., and fungi (8). These microbes require specific culture media and their growth is slow.…”