[Massive pancarditis-autopsy report]

Area of Science:

• Infectious Diseases
• Cardiology
• Rheumatology

Background:

• Whipple's disease is a rare bacterial infection typically affecting the gastrointestinal tract.
• It can manifest with diverse systemic symptoms, often mimicking other chronic conditions.
• Diagnosis can be challenging due to its varied clinical presentation.

Observation:

• A 69-year-old man with chronic arthritis presented with worsening cough and dyspnea.
• Clinical diagnosis was steroid-sensitive seronegative chronic arthritis.
• The patient experienced sudden death, with autopsy revealing massive pancarditis, including constrictive pericarditis and multivalvular endocarditis.

Findings:

• Molecular analysis of cardiac tissue identified Tropheryma whipplei.
• Tropheryma whipplei was not detected in duodenal or synovial tissues.
• The cause of death was determined to be acute cardiac failure secondary to Tropheryma whipplei-induced pancarditis.

Implications:

• This case underscores that Whipple's disease can present with cardiac manifestations and respiratory distress.
• It expands the differential diagnosis for chronic multisystem disorders with arthralgia.
• Increased awareness of atypical Whipple's disease presentations is crucial for timely diagnosis and treatment.