Tropheryma whipplei tricuspid endocarditis: a case report and review of the literature

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).

Tropheryma whipplei aortic valve endocarditis, cured without surgical treatment

“…As far as we know, this is the third case described with Tropheryma whipplei endocarditis cured without valve replacement [12]. …”

Whipple's in the valleys: a case of Whipple's with thrombocytopenia and endocarditis

“…A number of these culture-negative vegetations have been found in patients not displaying classical Whipple's disease abdominal symptoms 6. Endocarditis predominantly affects the mitral and aortic valves.…”

“…Endocarditis predominantly affects the mitral and aortic valves. Two cases of tricuspid valve endocarditis without classical abdominal symptoms have been previously described in the literature 6 7…”

Non-functional tricuspid valve disease

“…Cessation of fenfluramine o r m e t h y s e r g i d e h a s b e e n a s s o c i a t e d w i t h v a l v e normalization (28,29,31). Severe tricuspid regurgitation from a Whipple's plaque that seemed to coat the tricuspid valve leaflets without destroying them, reportedly resolved with antibiotics (15). There are reports of heart failure symptom improvement with attention to carcinoid, but the valvular pathology and severity of the underlying pathologic change in fact may actually worsen despite treatment of the disease (47).…”

“…Rarely, the tricuspid valve, and not just the aortic valve, can be made severely regurgitant by a typically culturenegative organism, Tropheryma whipplei, which can form a leaflet plaque and thus restriction of leaflets. This restriction is associated with either stenosis or regurgitation that may resolve with appropriate antibiotic treatment (7,15).…”