Key result
Valve replacement and lifelong antibiotic therapy with hydroxychloroquine and doxycycline led to complete disappearance of arthralgia and clinical recovery in a patient with Tropheryma whipplei bivalvular endocarditis.
Case Report (n=1)
This case highlights the importance of considering Tropheryma whipplei in blood culture-negative endocarditis, particularly when preceded by unexplained arthralgia, and suggests a potential role for lifelong antibiotic therapy.
May guide care in rare Tropheryma whipplei endocarditis; leaves open need for prospective validation.
INTRODUCTION: Tropheryma whipplei infection should be considered in patients with suspected infective endocarditis with negative blood cultures. The case (i) shows how previous symptoms can contribute to the diagnosis of this illness, and (ii) elucidates current recommended diagnostic and therapeutic approaches to Whipple's disease. CASE PRESENTATION: A 71-year-old Swiss man with a past history of 2 years of diffuse arthralgia was admitted for a possible endocarditis with severe aortic and mitral regurgitation. Serial blood cultures were negative. Our patient underwent replacement of his aortic and mitral valve by biological prostheses. T. whipplei was documented by polymerase chain reactions on both removed valves and on stools, as well as by valve histology. A combination of hydroxychloroquine and doxycycline was initiated as lifetime treatment followed by the complete disappearance of his arthralgia. CONCLUSIONS: This case report underlines the importance of considering T. whipplei as a possible causal etiology of blood culture-negative endocarditis. Lifelong antibiotic treatment should be considered for this pathogen (i) due to the significant rate of relapses, and (ii) to the risk of reinfection with another strain since these patients likely have some genetic predisposition.
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Gruber et al. (2015) conducted a case report in Tropheryma whipplei bivalvular endocarditis and polyarthralgia (n=1). Valve replacement and lifelong antibiotics (hydroxychloroquine and doxycycline) was evaluated on Clinical recovery and resolution of symptoms. Valve replacement and lifelong antibiotic therapy with hydroxychloroquine and doxycycline led to complete disappearance of arthralgia and clinical recovery in a patient with Tropheryma whipplei bivalvular endocarditis.
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