[Whipple disease, initially diagnosed as sarcoidosis].
BACKGROUND
Whipple disease is a multisystem infectious disease caused by Tropheryma whipplei. We report a case in which an initial diagnosis of sarcoidosis was changed to Whipple disease endocarditis.


METHODS
Based on clinical, radiographic, endoscopic and histologic findings, this 61-year-old man was diagnosed with sarcoidosis. Initial response to corticotherapy was good, but the patient required 35 mg of prednisone daily. The subsequent onset of clinical and laboratory signs of inflammation cast doubt on the diagnosis. After cardiac ultrasound revealed a mass 1 cm in diameter on the mitral valve, apparently vegetation, we diagnosed culture-negative infective endocarditis and ruled out most possible causes. PCR of a duodenal biopsy sample showed Tropheryma whipplei, thus confirming the diagnosis of Whipple disease, despite normal histological findings. After 3 weeks of intravenous gentamicin and amoxicillin treatment, oral cotrimoxazole was substituted. Follow-up transesophageal ultrasound showed no mitral vegetation. The patient, still under cotrimoxazole, has been off prednisone for 13 months and is completely asymptomatic.


CONCLUSIONS
This case is an illustration of the difficulty in distinguishing Whipple disease from sarcoidosis in practice and of the importance of that distinction.
Saba
M
M
Service de médecine interne 2 du Pr D. Sicard, Université René Descartes, Hôpital Cochin, Paris. sabamona@hotmail.com
Rollot
F
F
Park
S
S
Grimaldi
D
D
Sicard
D
D
Abad
S
S
Blanche
P
P
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003951:Diagnostic Errors; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012507:Sarcoidosis / Q000175:diagnosis*; D008061:Whipple Disease / Q000175:diagnosis* / Q000188:drug therapy
D000900:Anti-Bacterial Agents