Cardiac Whipple Disease: Identification of Whipple Bacillus by Electron Microscopy in the Myocardium of a Patient before Death
Authors: F E Silvestry, B Kim, B J Pollack, J E Haimowitz, R K Murray, E E Furth, H L Nisenbaum, M L Kochman, N Freedman, R Pine, H C Herrmann
Journal: Annals of Internal Medicine (1997)

Brief Communications1 February 1997Cardiac Whipple Disease: Identification of Whipple Bacillus by Electron Microscopy in the Myocardium of a Patient before DeathFrank E. Silvestry, MD, Back Kim, MD, Bonnie J. Pollack, MD, Julia E. Haimowitz, MD, Richard K. Murray, MD, Emma E. Furth, MD, Harvey L. Nisenbaum, MD, Michael L. Kochman, MD, Neil Freedman, MD, Rogelio Pine, MD, and Howard C. Herrmann, MDFrank E. Silvestry, MDFrom the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey.Search for more papers by this author, Back Kim, MDFrom the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey.Search for more papers by this author, Bonnie J. Pollack, MDFrom the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey.Search for more papers by this author, Julia E. Haimowitz, MDFrom the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey.Search for more papers by this author, Richard K. Murray, MDFrom the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey.Search for more papers by this author, Emma E. Furth, MDFrom the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey.Search for more papers by this author, Harvey L. Nisenbaum, MDFrom the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey.Search for more papers by this author, Michael L. Kochman, MDFrom the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey.Search for more papers by this author, Neil Freedman, MDFrom the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey.Search for more papers by this author, Rogelio Pine, MDFrom the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey.Search for more papers by this author, and Howard C. Herrmann, MDFrom the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-3-199702010-00006 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Whipple disease was first described in 1907 in a 36-year-old patient with diarrhea, abdominal pain, weight loss, and polyarthritis [1]. The causative agent, now called Tropheryma whippelii, is closely related to the actinomycetes [2]. Whipple disease usually affects the intestinal tract but may involve other organ systems, including pulmonary and neurologic tissue [3, 4]. Macrophages that yield positive results on periodic acid-Schiff staining are characteristically seen in the lamina propria of the small bowel, and electron microscopy shows rod-shaped bacillary bodies that are believed to be the causative agent.Although overt cardiac involvement is rare, case reports have documented constrictive ...References1. Whipple GH. A hitherto undescribed disease characterized anatomically by deposits of fat and fatty acids in the intestinal and mesenteric lymphatic tissues. Bulletin of Johns Hopkins Hospital. 1907; 18:382-91. Google Scholar2. Relman DA, Schmidt TM, MacDermott RP, Falkow S. Identification of the uncultured bacillus of Whipple's disease. N Engl J Med. 1992; 327:293-301. Google Scholar3. Maizel H, Ruffin JM, Dobbins WO 3d. Whipple's disease: a review of 19 patients from one hospital and a review of the literature since 1950. Medicine (Baltimore). 1970; 49:175-205. Google Scholar4. Fleming JL, Wiesner RH, Shorter RG. Whipple's disease: clinical, biochemical, and histopathologic features and assessment of treatment in 29 patients. Mayo Clin Proc. 1988; 63:539-51. Google Scholar5. McAllister HA Jr, Fenoglio JJ Jr. Cardiac involvement in Whipple's disease. Circulation. 1975; 52:152-6. Google Scholar6. Pelech T, Fric P, Huslarova A, Jirasek A. Interstitial lymphocytic myocarditis in Whipple's disease [Letter]. Lancet. 1991; 337:553-4. Google Scholar7. de Takats PG, de Takats DL, Iqbal TH, Watson RD, Sheppard MN, Cooper BT. Symptomatic cardiomyopathy as a presentation in Whipple's disease. Postgrad Med J. 1995; 71:236-9. Google Scholar8. Upton AC. Histochemical investigation of mesenchymal lesions in Whipple's disease. Am J Clin Pathol. 1952; 22:755-64. Google Scholar9. Lie JT, Davis JS. Pancarditis in Whipple's disease: electronmicroscopic demonstration of intracardiac bacillary bodies. Am J Clin Pathol. 1976; 66:22-30. Google Scholar10. James TN, Bulkley BH. Abnormalities of the coronary arteries in Whipple's disease. Am Heart J. 1983; 105:481-91. Google Scholar11. Sossai P, DeBoni M, Cielo R. The heart and Whipple's disease [Letter]. Int J Cardiol. 1989; 23:275-6. Google Scholar12. Wendler D, Mendoza E, Schleiffer T, Zander M, Maier M. Tropheryma whippelii endocarditis confirmed by polymerase chain reaction. Eur Heart J. 1995; 16:424-5. Google Scholar Author, Article, and Disclosure InformationAuthors: Frank E. Silvestry, MD; Back Kim, MD; Bonnie J. Pollack, MD; Julia E. Haimowitz, MD; Richard K. Murray, MD; Emma E. Furth, MD; Harvey L. Nisenbaum, MD; Michael L. Kochman, MD; Neil Freedman, MD; Rogelio Pine, MD; Howard C. Herrmann, MDAffiliations: From the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey.Corresponding Author: Howard C. Herrmann, MD, Cardiovascular Division, University of Pennsylvania Medical Center, 9 Founder's Pavilion, 3400 Spruce Street, Philadelphia, PA 19104.Current Author Addresses: Drs. Silvestry and Herrmann: Cardiovascular Division, University of Pennsylvania Medical Center, 9 Founder's Pavilion, 3400 Spruce Street, Philadelphia, PA 19104. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMyocarditis and PericarditisAcute kidney injury in a 'well-filled patient': an unusual cause of elevated jugular venous pressureWhipple DiseaseMyocarditis and PericarditisWhipple's DiseaseWhipple's Disease and “ Tropheryma whippelii ”On the wide spectrum of abnormalities in the coronary arteries of Whippleʼs diseaseWhipple Endocarditis without Overt Gastrointestinal Disease: Report of Four CasesJacques G.H. Gubler, MD, Marcel Kuster, MD, Fabrizio Dutly, PhD, Fridolin Bannwart, MD, Martin Krause, MD, Hans Peter Vögelin, MD, Gianni Garzoli, MD, and Martin Altwegg, PhDWhipple’s disease with aortic regurgitation requiring aortic valve replacement 1 February 1997Volume 126, Issue 3Page: 214-216KeywordsBacillusBiopsyElectron microscopyHeartHeart diseasesHeart failureMyocarditisMyocardiumPeriodic acid SchiffStaining ePublished: 15 August 2000 Issue Published: 1 February 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...