Positron emission tomography in the diagnosis of Whipple's endocarditis: a case report
Sarah-Lyne Jos1, Emmanouil Angelakis2, Thierry Caus3
1URMITE CNRS-IRD 198 UMR 6236, Aix Marseille Université, Faculté de Médecine et de Pharmacie, 27 Bd Jean Moulin, 13385, Marseille, France. SARAH-LYNE.JOS@ap-hm.fr.
Background:
Whipple's disease is a systemic infection that sometimes is associated with cardiac manifestations. The diagnosis of Tropheryma whipplei endocarditis is still the result of chance because there are no diagnostic criteria and clinical signs are often those of cardiac disease rather than infection.
Case Presentation:
Culture-negative endocarditis was suspected in a non-febrile 77-year-old French woman from North France with a history of a graft replacement 4 years prior. Positron emission tomography revealed intense fluorodeoxyglucose uptake around the metal ring of the aortic graft. The valve was replaced, and T. whipplei was detected in a valve sample by molecular assays. Immunohistochemical staining of the valve for T. whipplei was also positive.
Conclusion:
The localization of infectious foci by positron emission tomography and systematically testing valve specimens for T. whipplei are promising for diagnosing Whipple's disease.
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