Tropheryma whipplei aortic valve endocarditis, cured without surgical treatment

Algin, Ahmet; Wegdam-Blans, Marjolijn C A; Verduin, Kees; Janssen, Hans W.; Dantzig, Jan-Melle van

doi:10.1186/1756-0500-5-600

Cited by 9 publications

(2 citation statements)

References 11 publications

(17 reference statements)

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“…Strangely enough, in the event this occurs, starting patients back on steroid treatment is the treatment when inadequate response to appropriate treatment is suspected [14]. Whipple's endocarditis, though oftentimes treated with surgery, has been treated successfully without surgical resection of valve tissue [15].…”

Section: Discussionmentioning

confidence: 99%

Thrombocytopenia and endocarditis in a patient with Whipple’s disease: case report

et al. 2020

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Background: Whipple's disease (WD) is a rare multisystem infectious disorder that is caused by the actinomycete Tropheryma whipplei. It presents with joint pain followed by abdominal pain, diarrhea, malabsorption and finally failure to thrive. Diagnosis requires tissue sampling and histology with periodic acid-Schiff [PAS] staining. Thrombocytopenia associated with endocarditis associated with WD has been reported twice. Case presentation: A 56 year old Caucasian male presented with years of steroid treated joint pain and recent onset diarrhea, weight loss and abdominal pain. Ultimately he was found to have a platelet count of 4000 with concomitant endocarditis and embolic stroke. Small bowel biopsy confirmed the diagnosis of WD approximately 1 year after his first visit. His platelets improved with antibiotic treatment but he eventually expired 16 months after his initial consult and 5 months after his definitive diagnosis. Conclusion: WD can remain undiagnosed and untreated until late in the course of the illness. A high index of suspicion is recognized as necessary for early diagnosis to begin treatment. Critical thrombocytopenia associated with endocarditis is a rare and potentially poor prognostic sign in late stage Whipple's disease.

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Section: Discussionmentioning

confidence: 99%

Thrombocytopenia and endocarditis in a patient with Whipple’s disease: case report

et al. 2020

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“…Immunohistochemical testing can improve the yield of histologic diagnosis. 9,10 Whipple's disease is notorious for masquerading as other inflammatory conditions (e.g., sarcoidosis), and many cases have been treated empirically with glucocorticoids. with the use of a polymerase-chain-reaction assay (e.g., from feces or saliva) has high sensitivity and specificity for the organism but should not be used in isolation for diagnosis.…”

Section: Commenta R Ymentioning

confidence: 99%

A Surprising Cause of Chronic Cough

Damaraju¹,

Steiner²,

Wade³

et al. 2015

N Engl J Med

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A 63-year-old nonsmoking white man presented to the clinic with a 2-year history of cough. The cough was dry, and it was worse at night. The cough had begun after an upper respiratory tract infection and a trip to South America. The patient was prescribed antibiotics by a family physician but had no improvement; he was then given a combination inhaler (salmeterol and fluticasone) and had minimal improvement.This patient has chronic cough, which is defined as a cough lasting more than 8 weeks. In a nonsmoker, the most common causes are the upper-airway cough syndrome (allergic, nonallergic, or infectious), asthma, and gastroesophageal reflux disease (GERD). This patient has features suggestive of GERD or the upperairway cough syndrome after an upper respiratory tract infection. Although the long duration of cough may suggest mild asthma, this condition should have improved substantially with the correct use of a combination inhaler.The patient's medical history included at least 5 years of intermittent arthralgias and myalgias and a 2-year history of night sweats (now resolved) before this presentation. The arthralgias occurred in his neck, shoulders, wrists, hands, hips, and ankles; episodes would last 2 weeks on average, followed by complete recovery. He was assessed by a rheumatologist during the first 2 years after the onset of these symptoms and had negative results on tests for antinuclear antibody (rheumatoid factor, extractable nuclear antigens, and anti-cyclic citrullinated peptide antibodies) and HLA-B27. A tuberculin skin test, chest radiography, and ultrasonography of the abdomen were also negative. Additional medical history included pitting edema in the lower limbs bilaterally for the past 2 years (attributed to venous stasis), for which the patient used compression stockings. There was no other clinically significant medical history. The patient had never smoked, and he drank minimal amounts of alcohol. He had no pets. His only medications were the inhaler and ibuprofen (as needed).In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. The New England Journal of Medicine Downloaded from nejm.org at EMORY UNIVERSITY on August 5, 2015. For personal use only. No other uses without permission.

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