Whipple's disease can present primarily as aortic insufficiency prior to typical systemic or gastrointestinal symptoms.
CONGESTIVE heart failure, pericardial friction rubs, systolic murmurs, nonspecific electrocardiographic changes, and hypotension usually herald cardiac involvement in patients with Whipple's disease and occur after documentation of disease in the small intestine.1 2 3 4 5 6 7 8 9 10 11 12 Cardiac manifestations are associated with collections of periodic acid–Schiff (PAS)-positive macrophages within the pericardium and myocardium,1 2 3 4 5 6 7 8 9 10 , 13 and these cells may also give rise to endocardial and valvular vegetations, usually of the mitral valve.1 , 2 , 6 , 12 Our clinical observation of a middle-aged woman has revealed that Whipple's disease may present as aortic insufficiency before clinically apparent intestinal, articular, or systemic involvement, despite the presence of widespread disease.Case ReportIn January . . .
Bostwick et al. (Thu,) studied this question.
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