Authors
Abdallatif Dawoud, Mohammad Safi, Maddy Taylor, Raghad Elhag, Oun Al-Dalahmeh, Omar Horani, Li Wang, Samer J Khouri
Published in
Case reports in cardiology. Volume 2026. Pages 1675151. Epub Sep 12, 2026.
Abstract
Tropheryma whipplei (T. whipplei) is a rare cause of culture-negative infective endocarditis and may present without classic gastrointestinal manifestations, leading to delayed diagnosis and severe valvular destruction.
A 76-year-old man with a prior bioprosthetic aortic valve replacement presented with at least 2 weeks of fatigue, generalized weakness, intermittent chills, and worsening dyspnea, along with approximately 8 kg of unintentional weight loss since the preceding summer; he remained afebrile. Blood cultures remained persistently negative. Transesophageal echocardiography revealed a > 3-cm vegetation, prosthetic valve dehiscence, severe paravalvular regurgitation, and periannular abscess. Despite empiric broad-spectrum antibiotics and urgent surgical evaluation, the patient deteriorated and suffered cardiac arrest. Whole-blood polymerase chain reaction testing collected during hospitalization returned positive for T. whipplei after the patient's death, establishing the diagnosis.
Whipple endocarditis typically presents as culture-negative disease and often lacks systemic features, delaying recognition. This case highlights the diagnostic challenge posed by T. whipplei in prosthetic valve endocarditis and the value of molecular testing when conventional cultures remain negative.
Early PCR testing should be considered in culture-negative prosthetic endocarditis, as it may establish a diagnosis when conventional cultures and valve tissue are unavailable.
PMID:
42732384
Bibliographic data and abstract were imported from PubMed on 13 Sep 2026.
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