Treatment refractory arthritis and stroke – A case of infective endocarditis caused by Tropheryma whipplei
(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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- author
- Ujaimi, Ziyad ; Bjursten, Henrik LU ; Vucicevic, Sanja ; Brunnström, Hans LU ; Gilje, Patrik LU ; Rasmussen, Magnus LU and Ragnarsson, Sigurdur LU
- organization
-
- Less invasive cardiac surgery (research group)
- Thoracic Surgery
- Pathology, Lund
- Improved diagnostics and prognostics of lung cancer and metastases to the lungs (research group)
- Molecular Cardiology (research group)
- Cardiology
- Translational infection medicine (research group)
- Infection Medicine (BMC)
- Heparin bindning protein in cardiothoracic surgery (research group)
- Bleeding disorders and acute typ-A dissection (research group)
- Minimal invasive cardiac surgery in valvular heart disease (research group)
- publishing date
- 2023-01
- 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
- 2024-09-07 11:33:54
@article{5acba0db-598f-4efa-8e48-3556ed59b8f2, abstract = {{<p>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.</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}}, }