Broad-range PCR and PAS staining of the excised valve successfully diagnosed Tropheryma whipplei as the cause of culture-negative prosthetic valve endocarditis in a 50-year-old man.
Case Report (n=1)
No
Whipple's disease should be considered in culture-negative prosthetic valve endocarditis, with diagnosis relying on PAS staining and broad-range PCR of excised valves.
Abstract Background: Whipple’s disease is a chronic multisystemic infectious disease that rarely presents as culture-negative endocarditis. Most patients reported with Tropheryma whipplei endocarditis involve a native valve and few describe prosthetic valve disease. Case presentation: A patient with chronic polyarthritis and previous mitral valve replacement developed decompensated heart failure without fever. Transesophageal echocardiography revealed a prosthetic mitral valve vegetation and he underwent prosthetic mitral valve replacement. Blood and prosthetic mitral valve cultures were unrevealing. Broad-range polymerase chain reaction (PCR) of the extracted valve and subsequent Periodic-acid-Schiff (PAS) staining established the diagnosis of T. whipplei prosthetic valve endocarditis. Conclusion: Whipple’s disease may present as culture-negative infective endocarditis and affect prosthetic valves. Histopathology with PAS staining and broad-range PCR of excised valves are essential for the diagnosis. Greater clinical awareness and implementation of these diagnostic procedures should result in an increased reported incidence of this rare disease.
Kahn et al. (Fri,) conducted a case report in Prosthetic valve endocarditis secondary to Tropheryma whipplei (n=1). Broad-range PCR and PAS staining for diagnosis, followed by valve replacement and antibiotics was evaluated on Diagnosis of Tropheryma whipplei endocarditis. Broad-range PCR and PAS staining of the excised valve successfully diagnosed Tropheryma whipplei as the cause of culture-negative prosthetic valve endocarditis in a 50-year-old man.
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