Summary
Cardiac involvement in Whipple’s disease is well established. However, clinical consequences beside antibiotic therapy have rarely been reported. Our observation of a middle-aged man with increasing dyspnea, fatigue, chest pain, and dizziness leading to admission to a cardiology department demonstrates that cardiac symptoms may represent the main symptoms in patients with Whipple’s disease. The diagnosis was not made prior to upper endoscopy, performed because of diarrhea, and revealed Whipple’s agent now classified asTropheryma whippelii, which is a PAS-positive rod-shaped bacterium in the macrophages of the intestinal lamina propria. The aortic valve was replaced after the intestinal symptoms were resolved by antibiotic treatment reducing the number of infectious agents in the duodenal mucosa. Histological analysis of the aortic valve demonstrated the presence of PAS-positive rod shaped material as the most likely cause of aortic insufficiency. Five months after valve replacement, the patient had completely recovered from intestinal and cardiac symptoms. Still under antibiotic treatment 16 months later, no more PAS-positive macrophages were detectable in the intestinal mucosa.
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Whipple, G. H.: A hitherto undescribed disease characterized by deposits of fat and fatty acids in the intestinal and mesenteric lymphatic tissues. Johns Hopkins Hosp. Bull. 18 (1907) 382–391.
Fleming, J. L., Wiesner, R. H., Shorter, R. G.: Whipple’s disease: clinical, biochemical, and histopathologic features and assessment of treatment in 29 patients. Mayo Clin. Proc. 63 (1988) 539–551.
Upton, A. C.: Histochemical investigation of mesenchymal lesions in Whipple’s disease. Am. J. Clin. Pathol. 22 (1952) 755–764.
Lie, J. T., Davis, J. S.: Pancarditis in Whipple’s disease: electromicroscopic demonstration of intracardiac bacillary bodies. Am. J. Clin. Pathol. 66 (1976) 22–30.
Wright, C. B., Hiratzka, L. F., Crossland, S., Isner, J., Snow, J. A.: Aortic insufficiency requiring valve replacement in Whipple’s disease. Ann. Thorac. Surg 1978 (1978) 466–469.
Bostwick, D. G., Bensch, K. G., Burke, J. S., Billingham, J. S., Miller, D. C., Smith, J. C., Keren, D. F.: Whipple’s disease presenting as aortic insufficiency. N. Engl. J. Med. 300 (1981) 907–908.
Bauer, T. M., Potratz, D., Göller, T., Wagner, A., Schäfer, R.: Qualitätskontrolle durch Autopsie. Wie häufig korrigiert der Obduktionsbefund die klinische Diagnose? Dtsch. Med. Wochenschr. 116 (1991) 801–807.
Silvestry, F. E., Kim, B., Pollack, B. J., Haimowitz, J. E., Murray, R. K., Furth, E. E., Nisenbaum, H. L., Kochman, M. L., Freedman, N., Pine, R., Herrmann, H. C.: Cardiac Whipple disease: identification of Whipple bacillus by electron microscopy in the myocardium of a patient before death. Ann. Intern. Med. 126 (1997) 214–216.
Yardley, J. H., Hendrix, T. R.: Combined electron and light microscopy in Whipple’s disease: demonstration of “bacillary bodies” in the intestine. Johns Hopkins Hosp. Bull. 109 (1961) 80–98.
Relman, D. A., Schmidt, T. M., MacDermott, R. P., Falkow, S.: Identification of the uncultured bacillus of Whipple’s disease. N. Engl. J. Med. 327 (1992) 293–301.
von Herbay, A., Ditton, H.-J., Maiwald, M.: Diagnostic application of a polymerase chain reaction assay for the Whipple’s disease bacterium to intestinal biopsies. Gastroenterology 110 (1996) 1735–1743.
McAllister, H. A. J., Fenoglio, J. J. J.: Cardiac involvement in Whipple’s disease. Circulation 52 (1975) 152–156.
Ratliff, N., McMahon, J. T., Naab, T. J., Cosgrove, D. M.: Whipple’s disease in the porcine leaflets of a Carpentier-Edwards prosthetic mitral valve. N. Engl. J. Med. 14 (1988) 902–903.
Maizel, H., Ruffin, J. M., Dobbins, W. O.: Whipple’s disease: a review of 19 patients from one hospital and a review of the literature since 1950. Medicine 49 (1970) 175–205.
Kraunz, R. F.: Whipple’s disease with cardiac and renal abnormalities. Arch. Intern. Med. 123 (1969) 701–706.
Pastor, B. M.: Whipple’s disease presenting as pleuropericarditis. Am. J. Med. 55 (1973) 827–831.
Bienvenu, P., Groussin, P., Metman, E.-H., Medelsi, M., Morand, P.: Maladie de Whipple avec localisations cardiaques. Ann. Cardiol. Angiol. 25 (1976) 207–216.
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Schneider, T., Salamon-Looijen, M., von Herbay, A. et al. Whipple’s disease with aortic regurgitation requiring aortic valve replacement. Infection 26, 178–180 (1998). https://doi.org/10.1007/BF02771847
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DOI: https://doi.org/10.1007/BF02771847