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Treatment refractory arthritis and stroke – A case of infective endocarditis caused by Tropheryma whipplei

Ujaimi, Ziyad ; Bjursten, Henrik LU ; Vucicevic, Sanja ; Brunnström, Hans LU orcid ; Gilje, Patrik LU ; Rasmussen, Magnus LU and Ragnarsson, Sigurdur LU (2023) In IDCases 32.
Abstract

Whipple´s disease is a rare multisystem condition affecting < 1/1.000.000 per year. The condition often presents with polyarthritis, diarrhea, and intestinal malabsorption. Endocarditis is seen in a minority of these patients, and is typically culture negative, as the causative agent Tropheryma whipplei does not grow in ordinary culture media. We present the case of a 78-year-old man with a history of seronegative polyarthritis that was refractory to treatment with several biological agents for a duration of 5 years prior to presentation to the emergency department with stroke. Echocardiography revealed aortic valve endocarditis with a 3.6 cm vegetation and multiple smaller vegetations. The patient underwent surgery with aortic valve... (More)

Whipple´s disease is a rare multisystem condition affecting < 1/1.000.000 per year. The condition often presents with polyarthritis, diarrhea, and intestinal malabsorption. Endocarditis is seen in a minority of these patients, and is typically culture negative, as the causative agent Tropheryma whipplei does not grow in ordinary culture media. We present the case of a 78-year-old man with a history of seronegative polyarthritis that was refractory to treatment with several biological agents for a duration of 5 years prior to presentation to the emergency department with stroke. Echocardiography revealed aortic valve endocarditis with a 3.6 cm vegetation and multiple smaller vegetations. The patient underwent surgery with aortic valve replacement followed by prolonged antibiotic treatment. 16 S rDNA PCR analysis of the resected valve revealed T. whipplei as the causative agent. Two years after surgery and treatment with antibiotics, the patient's previously longstanding arthritis had totally disappeared and all rheumatological treatment had been discontinued.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Culture-negative infective endocarditis, Immunomodulatory agents, Seronegative arthritis, Whipple's disease
in
IDCases
volume
32
article number
e01800
publisher
Elsevier
external identifiers
  • pmid:37255692
  • scopus:85159686497
ISSN
2214-2509
DOI
10.1016/j.idcr.2023.e01800
language
English
LU publication?
yes
additional info
Funding Information: This work was supported a grant to Sigurdur Ragnarsson from the Swedish State under the agreement between the Swedish Government and the County Councils concerning economic support of research and education of doctors (ALF agreement). Publisher Copyright: © 2023
id
5acba0db-598f-4efa-8e48-3556ed59b8f2
date added to LUP
2023-05-29 10:58:20
date last changed
2024-06-15 03:29:29
@article{5acba0db-598f-4efa-8e48-3556ed59b8f2,
  abstract     = {{<p>Whipple´s disease is a rare multisystem condition affecting &lt; 1/1.000.000 per year. The condition often presents with polyarthritis, diarrhea, and intestinal malabsorption. Endocarditis is seen in a minority of these patients, and is typically culture negative, as the causative agent Tropheryma whipplei does not grow in ordinary culture media. We present the case of a 78-year-old man with a history of seronegative polyarthritis that was refractory to treatment with several biological agents for a duration of 5 years prior to presentation to the emergency department with stroke. Echocardiography revealed aortic valve endocarditis with a 3.6 cm vegetation and multiple smaller vegetations. The patient underwent surgery with aortic valve replacement followed by prolonged antibiotic treatment. 16 S rDNA PCR analysis of the resected valve revealed T. whipplei as the causative agent. Two years after surgery and treatment with antibiotics, the patient's previously longstanding arthritis had totally disappeared and all rheumatological treatment had been discontinued.</p>}},
  author       = {{Ujaimi, Ziyad and Bjursten, Henrik and Vucicevic, Sanja and Brunnström, Hans and Gilje, Patrik and Rasmussen, Magnus and Ragnarsson, Sigurdur}},
  issn         = {{2214-2509}},
  keywords     = {{Culture-negative infective endocarditis; Immunomodulatory agents; Seronegative arthritis; Whipple's disease}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{IDCases}},
  title        = {{Treatment refractory arthritis and stroke – A case of infective endocarditis caused by Tropheryma whipplei}},
  url          = {{http://dx.doi.org/10.1016/j.idcr.2023.e01800}},
  doi          = {{10.1016/j.idcr.2023.e01800}},
  volume       = {{32}},
  year         = {{2023}},
}