title: [Whipple's disease endocarditis: report of 5 cases and review of the literature].
abstract: OBJECTIVE
  Endocarditic lesions (infectious endocarditis) associated with Whipple's disease are exceptional. We report five cases from the cardiovascular and pneumologic hospital Louis Pradel in Lyon.
  
  
  METHODS
  We have collected all cases of Tropheryma whipplei endocarditis diagnosed between 1995 and 2004.
  
  
  RESULTS
  Five men with a mean age of 53 years at time of diagnosis. The symptoms were essentially cardiovascular: murmur, embolism in 3 cases, and heart failure secondary to valvular insufficiency in 2 cases. The valvular involvement, double in 3 cases, was more often aortic. Vegetations were present in all patients and valvular destruction sometimes very important. A low grade fever was present in 4 cases, associated with weight loss in 2 cases. The only extra-cardiac symptoms were arthralgias or arthritis in all cases, considered in 3 patients as seronegative rheumatoid arthritis, B27+ spondylarthritis, and psoriasic arthritis. Their was no other clinical manifestations of Whipple's disease, particularly digestive, ocular, neurologic or adenopathy, and duodenal biopsies secondarily performed in 4 cases were non contributive. This differs from literature as an extra-cardiac location was identified in 11 out of 17 cases. The diagnosis was obtained by histology and PCR on the cardiac valves, as all the patients underwent surgery. The evolution was favourable with a prolonged antibiotic therapy.
  
  
  CONCLUSIONS
  These report confirms the existence of endocarditic forms of the Whipple's disease, in which the single extra-cardiac manifestation is rheumatologic, and reminds us the usefulness of histology and PCR on the cardiac valves at the time of valvular surgery.
authors.affiliation: Service de bactériologie, hôpital Louis-Pradel, 59, boulevard Pinel, 69500 Bron, France. hayat.aiouaz@perharidy.fr
authors.forename: H
authors.initials: H
authors.lastname: Aïouaz
authors.forename: M
authors.initials: M
authors.lastname: Célard
authors.forename: M
authors.initials: M
authors.lastname: Puget
authors.forename: F
authors.initials: F
authors.lastname: Vandenesch
authors.forename: A
authors.initials: A
authors.lastname: Mercusot
authors.forename: F
authors.initials: F
authors.lastname: Fenollar
authors.forename: F
authors.initials: F
authors.lastname: Delahaye
authors.forename: J F
authors.initials: JF
authors.lastname: Obadia
authors.forename: J
authors.initials: J
authors.lastname: Tebib
authors.forename: H
authors.initials: H
authors.lastname: Rousset
mesh_terms: D039903:Actinobacteria / Q000302:isolation & purification; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery; D015535:Arthritis, Psoriatic / Q000150:complications; D001172:Arthritis, Rheumatoid / Q000150:complications; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D025241:Spondylarthritis / Q000150:complications; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000209:etiology / Q000601:surgery; D008061:Whipple Disease / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents