Whipple endocarditis without overt gastrointestinal disease: report of four cases.

BACKGROUND

Cardiac manifestations of Whipple disease are rarely diagnosed before death.

OBJECTIVE

To describe four patients with endocarditis caused by Tropheryma whippelii who did not have overt gastrointestinal disease.

METHODS

Case series.

METHODS

Five hospitals in eastern Switzerland.

METHODS

Three men and one woman undergoing replacement of insufficient heart valves.

METHODS

Histologic characteristics of heart valves and intestinal biopsy; broad-range and specific polymerase chain reaction for T. whippelii.

RESULTS

Tropheryma whippelii was found in the heart valves (three aortic valves and one mitral valve) of four patients with culture-negative endocarditis necessitating valve replacement. All patients had arthralgia for different lengths of time. Only one patient had mild gastrointestinal symptoms. Histologic characteristics of intestinal mucosa were normal in all patients, and polymerase chain reaction on intestinal biopsy was positive for T. whippelii in only one patient, who did not have diarrhea. In all patients, arthralgia resolved promptly after institution of antibiotic therapy. Disease did not recur in any patient after prolonged antibiotic therapy with cotrimoxazole.

CONCLUSIONS

In patients with culture-negative endocarditis, the absence of clinical, microscopic, or microbiological evidence of gastrointestinal disease did not rule out T. whippelii.