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Prosthetic valve endocarditis secondary to Tropheryma whipplei in a patient with chronic polyarthritis

Mauricio J Kahn1, David M Ennis2, Dennis G Delgado2

  • 1Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Blvd, THT 229, Birmingham, AL, 35294, USA. mkahnchau@uabmc.edu.

Journal of Cardiothoracic Surgery
|April 29, 2023
PubMed
Abstract

Insights

Whipple's disease, a rare infection, can mimic culture-negative endocarditis, even on prosthetic valves. Diagnosis requires specific histopathology and PCR on excised valves.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Microbiology

Background:

  • Whipple's disease is a rare chronic multisystemic infection.
  • It infrequently presents as culture-negative endocarditis.
  • Prosthetic valve involvement is seldom reported.

Observation:

  • A patient with polyarthritis and mitral valve replacement developed heart failure.
  • Echocardiography showed prosthetic valve vegetation.
  • Valve replacement was performed, but cultures were negative.

Findings:

  • Periodic-acid-Schiff (PAS) staining of the excised valve revealed Tropheryma whipplei.
  • Broad-range polymerase chain reaction (PCR) confirmed T. whipplei prosthetic valve endocarditis.
  • This case highlights a rare presentation of Whipple's disease.

Implications:

  • Whipple's disease should be considered in culture-negative endocarditis, including prosthetic valves.
  • Histopathology (PAS) and PCR on excised valves are crucial for diagnosis.
  • Increased clinical awareness can improve detection rates of this uncommon condition.
Keywords:
Culture-negative endocarditisProsthetic valve endocarditisWhipple’s endocarditis

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