Background: Cardiac manifestations of Whipple disease are rarely diagnosed
Objective: To describe four patients with endocarditis caused by Tropheryma
whippelii who did not have overt gastrointestinal disease.
Design: Case series.
Setting: Five hospitals in eastern Switzerland.
Patients: Three men and one woman undergoing replacement of insufficient he
Measurements: Histologic characteristics of heart valves and intestinal bio
psy; broad-range and specific polymerase chain reaction for T. whippelii.
Results: Tropheryma whippelii was found in the heart valves (three aortic v
alves and one mitral valve) of four patients with culture-negative endocard
itis necessitating valve replacement. All patients had arthralgia for diffe
rent lengths of time. Only one patient had mild gastrointestinal symptoms.
Histologic characteristics of intestinal mucosa were normal in all patients
, and polymerase chain reaction on intestinal biopsy was positive for T. wh
ippelii in only one patient, who did not have diarrhea, In all patients, ar
thralgia resolved promptly after institution of antibiotic therapy. Disease
did not recur in any patient after prolonged antibiotic therapy with cotri
Conclusion: In patients with culture-negative endocarditis, the absence of
clinical, microscopic, or microbiological evidence of gastrointestinal dise
ase did not rule out T, whippelii.