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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
Summary
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.