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Case Reports
. 2025 Aug 20;2025(8):omaf140.
doi: 10.1093/omcr/omaf140. eCollection 2025 Aug.

A new case of Tropheryma whipplei infective endocarditis

Rova Malala Fandresena Randrianarisoa  1   2 , Mathilde Tonnelier  3 , Morgane Mailhe  4 , Marylou Para  5 , Anne-Lise Lecapitaine  3
Affiliations
Case Reports

A new case of Tropheryma whipplei infective endocarditis

Rova Malala Fandresena Randrianarisoa et al. Oxf Med Case Reports. .

Abstract

Introduction: Infective endocarditis is a rare complication of untreated Whipple's disease. We present a case of infective endocarditis caused by Tropheryma whipplei in an aortic bioprosthesis.

Case presentation: A 77-year-old man with a bioprosthetic aortic valve and pacemaker presented with two months of fever. He had a history of HLA-B27-negative ankylosing spondylitis treated with adalimumab. Examination revealed a systolic aortic murmur. Transthoracic echocardiography revealed vegetation on the aortic bioprosthetis. Serologies and cultures were negative. He underwent valve replacement, endocavitary pacemaker system removal, and epicardial pacemaker implantation. Valve tissue PCR and 16S rRNA sequencing were positive for T. whipplei. Empiric ceftriaxone was given for two weeks, followed by doxycycline and hydroxychloroquine for 12 months, then lifelong doxycycline monotherapy.

Conclusion: Whipple's endocarditis is difficult to diagnose due to its atypical presentation and frequent failure to meet Duke criteria. Tissue PCR plays a crucial role when standard microbiologic testing is inconclusive.

Keywords: T. whipplei infective endocarditis; Tropheryma whipplei; blood culture; infective endocarditis; polymerase chain reaction.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Transthoracic echocardiographic findings in our patient. (A) Thickening of the aortic valve with visible vegetation (yellow arrow). (B) Magnified view of image a, highlighting the vegetation on the aortic valve (yellow arrow). (C) Five-chamber e chocardiographic view showing vegetation on the aortic valve (yellow highlight). (D) Continuous-wave Doppler assessment of the aortic valve in the five-chamber view, demonstrating flow characteristics consistent with severe aortic stenosis. AO: Aorta; LA: Left atrium; LV: Left ventricle.
See this image and copyright information in PMC

References

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