Valvular Endocarditis and Biventricular Heart Failure in the Setting of Tropheryma whipplei Disease

Abstract

Whipple disease is a rare systemic illness associated with weight loss, diarrhea, and arthralgia. Asymptomatic carriage is common, but the disease can be complicated by cardiac involvement and may result in culture-negative endocarditis. Cardiac manifestations of the disease can lead to death. This report presents the case of a 66-year-old man with Whipple disease and biventricular heart failure with cardiogenic shock. Medical therapy followed by successful replacement of the aortic and mitral valves resulted in substantial improvement.

Keywords: Tropheryma; Endocarditis; heart failure.

Fig. 1

A) Intraoperative prebypass transesophageal echocardiogram without (left) and with Doppler technique (right). Midesophageal still frame in early systole (left) shows the posteromedial aspect of the posterior leaflet of the mitral valve (arrow), with evidence of postinflammatory changes, including thickening, retraction, and decreased mobility. These changes generate a jet of moderate to severe mitral valve regurgitation (right; asterisk). B) Intraoperative prebypass transesophageal echocardiogram without (left) and with Doppler technique (right). Midesophageal still frame of the aortic valve (left) shows thickening/calcification at the coaptation (central arrow) and at the bases of the cusps (upper and lower arrows), resulting in moderate central aortic valve regurgitant jet (right; asterisk). Supplemental motion images available for Figure 1A and Figure 1B. Ao, aorta; LA, left atrium; LV, left ventricle; LVOT, left ventricular outflow tract.

Fig. 2

Intraoperative photograph of the mitral valve, where Tropheryma whipplei endocarditis appears as a thickened bowing tissue.