Tropheryma whipplei tricuspid endocarditis: a case report and review of the literature

Abstract

Introduction: The main clinical manifestations of Whipple's disease are weight loss, arthropathy, diarrhea and abdominal pain. Cardiac involvement is frequently described. However, endocarditis is rare and is not usually the initial presentation of the disease. To the best of our knowledge, this is the first reported case of a patient with Tropheryma whipplei tricuspid endocarditis without any other valve involved and not presenting signs of arthralgia and abdominal involvement.

Case presentation: We report a case of a 50-year-old Caucasian man with tricuspid endocarditis caused by Tropheryma whipplei, showing signs of severe shock and an absence of other more classic clinical signs of Whipple's disease, such as arthralgia, abdominal pain and diarrhea. Tropheryma whipplei was documented by polymerase chain reaction of the blood and pleural fluid. The infection was treated with a combined treatment of doxycycline, hydroxychloroquine and sulfamethoxazole-trimethoprim for one year.

Conclusion: Tropheryma whipplei infectious endocarditis should always be considered when facing a blood-culture negative endocarditis particularly in right-sided valves. Although not standardized yet, treatment of Tropheryma whipplei endocarditis should probably include a bactericidal antibiotic (such as doxycycline) and should be given over a prolonged period of time (a minimum of one year).

Figure 1

Transthoracic echocardiography at time of diagnosis showing large vegetations on the tricuspid valve caused by Tropheryma whipplei. The tricuspid valve is indicated by an arrow. VD; right ventricle: OD; right atrium.

Figure 2

Transthoracic echocardiography after one year of treatment. No vegetation was found. The tricuspid valve is indicated by an arrow. VD; right ventricle: OD; right atrium: VG; left ventricle: OG; left atrium.