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Cardiac Whipple's disease without digestive symptoms

C Elkins1, T A Shuman, J S Pirolo

  • 1Cardiovascular Surgery Associates, PC, Nashville, Tennessee 37205, USA.

The Annals of Thoracic Surgery
|March 23, 1999
PubMed

Insights

Whipple's disease can impact the heart, leading to serious cardiac conditions. This case highlights a rare presentation of Whipple's disease diagnosed during heart valve surgery.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Gastroenterology

Background:

  • Whipple's disease is a rare bacterial infection typically affecting the gastrointestinal tract.
  • Cardiac involvement, including endocarditis, pericarditis, and myocarditis, can occur but is less common.
  • Diagnosis can be challenging, especially in patients without classic gastrointestinal symptoms.

Observation:

  • A 43-year-old male presented for mitral and aortic valve replacement due to endocarditis.
  • The patient exhibited no preceding gastrointestinal symptoms suggestive of Whipple's disease.
  • The diagnosis of Whipple's disease was established intraoperatively.

Findings:

  • Whipple's disease can manifest primarily with cardiac symptoms, mimicking other forms of infective endocarditis.
  • Intraoperative diagnosis is possible in atypical presentations of Whipple's disease.
  • Bacterial endocarditis in this case was attributed to Tropheryma whipplei.

Implications:

  • This case underscores the importance of considering Whipple's disease in the differential diagnosis of culture-negative endocarditis, even without GI symptoms.
  • Early recognition and treatment of cardiac Whipple's disease are crucial to prevent severe cardiac complications.
  • Further research into non-classical presentations of Whipple's disease is warranted.

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