Gabus et al. Journal of Medical Case Reports 2010, 4:245 http://www.jmedicalcasereports.com/content/4/1/245 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Tropheryma whipplei tricuspid endocarditis: a case report and review of the literature Vincent Gabus1*, Zita Grenak-Degoumois2, Severin Jeanneret1, Riana Rakotoarimanana2, Gilbert Greub3,4, Daniel Genné2 Abstract Introduction: The main clinical manifestations of Whipple’s disease are weight loss, arthropathy, diarrhea and abdominal pain. Cardiac involvement is frequently described. However, endocarditis is rare and is not usually the initial presentation of the disease. To the best of our knowledge, this is the first reported case of a patient with Tropheryma whipplei tricuspid endocarditis without any other valve involved and not presenting signs of arthralgia and abdominal involvement. Case presentation: We report a case of a 50-year-old Caucasian man with tricuspid endocarditis caused by Tropheryma whipplei, showing signs of severe shock and an absence of other more classic clinical signs of Whipple’s disease, such as arthralgia, abdominal pain and diarrhea. Tropheryma whipplei was documented by polymerase chain reaction of the blood and pleural fluid. The infection was treated with a combined treatment of doxycycline, hydroxychloroquine and sulfamethoxazole-trimethoprim for one year. Conclusion: Tropheryma whipplei infectious endocarditis should always be considered when facing a blood-culture negative endocarditis particularly in right-sided valves. Although not standardized yet, treatment of Tropheryma whipplei endocarditis should probably include a bactericidal antibiotic (such as doxycycline) and should be given over a prolonged period of time (a minimum of one year). Introduction The Gram positive bacillus Tropheryma whippelii was first characterized by polymerase chain reaction (PCR) in the early 1990s [1], and renamed Tropheryma whip- plei in 2001 after its first culture and characterization [2]. The main clinical manifestations of Whipple’s dis- ease are weight loss (in 80 to 90% of reported cases), arthropathy (70 to 90%), diarrhea (70 to 85%) and abdominal pain (50 to 90%) [3]. Cardiac involvement is reported in 17 to 55% of patients with classical Whip- ple’s disease, pericarditis being the most frequent [4]. Endocarditis, however, is rare and 88% of cases occur in patients with healthy valves without underlying disease [5]. Endocarditis was the initial presentation of only a few cases [6-10]. We report a case of a patient with tri- cuspid endocarditis due to Tropheryma whipplei and review all previously reported cases. * Correspondence: vincent.gabus@chuv.ch 1Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland Full list of author information is available at the end of the article Case presentation A 50-year-old Caucasian alcoholic man presented to the emergency department with generalized weakness lasting 10 days and a history of weight loss. He had no other complaints. His history was significant for excessive alco- hol intake and cachexia. At the emergency department, the patient was weak but alert, appeared ill and was very pale. The clinical exam revealed: a temperature of 35.9°C, blood pressure 60/38 mm Hg; a heart rate of 95 beats per minute, a respiratory rate of 23 breaths per minute, bilateral ankle edema, buccal candidiasis, and a faint sys- tolic murmur. The neurological exam was normal, except for psychomotor slowing and a fine tremor. Laboratory results showed: hemoglobin 42 g/l, platelet count 23 G/l, WBC 4.9 G/l (normally distributed), C-reactive protein 21 mg/l (N < 5), hypoalbuminaemia and cholestasis. Other laboratory tests were normal. A chest radiograph showed cardiomegaly and pulmonary vascular redistribu- tion with bilateral pleural fluid accumulation. Computed tomography (CT) imaging excluded aortic dissection, massive pulmonary embolism, pericardial fluid and © 2010 Gabus et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.