Whipple's disease with aortic regurgitation requiring aortic valve replacement

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 demo...

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Bibliographic Details
Published in:Infection 1998-05, Vol.26 (3), p.178-180
Main Authors: SCHNEIDER, T, SALAMON-LOOIJEN, M, VON HERBAY, A, SCHWERDT, H, WEG-REMERS, S, STALLMACH, A, ZEITZ, M
Format: Article
Language:English
Subjects:
Antibiotics
Aorta
Aortic valve
Aortic Valve - pathology
Aortic Valve - surgery
Aortic Valve Insufficiency - diagnosis
Aortic Valve Insufficiency - microbiology
Aortic Valve Insufficiency - pathology
Aortic Valve Insufficiency - surgery
Biological and medical sciences
Cardiology
Cardiology. Vascular system
Diagnosis, Differential
Diarrhea
Duodenum - microbiology
Duodenum - pathology
Dyspnea
Endocardial and cardiac valvular diseases
Endoscopy
Health services
Heart
Heart diseases
Heart Valve Prosthesis Implantation
Heart valves
Humans
Intestinal Mucosa - microbiology
Intestinal Mucosa - pathology
Intestine
Lamina propria
Macrophages
Male
Medical sciences
Middle Aged
Mucosa
Patients
Regurgitation
Respiration
Signs and symptoms
Surgeons
Whipple Disease - complications
Whipple's disease
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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 as Tropheryma 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.
ISSN:0300-8126
1439-0973
1439-0972
DOI:10.1007/BF02771847