title: Tropheryma whipplei tricuspid endocarditis: a case report and review of the literature.
abstract: BACKGROUND
  The main clinical manifestations of Whipple's disease are weight loss, arthropathy, diarrhea and abdominal pain. Cardiac involvement is frequently described. However, endocarditis is rare and is not usually the initial presentation of the disease. To the best of our knowledge, this is the first reported case of a patient with Tropheryma whipplei tricuspid endocarditis without any other valve involved and not presenting signs of arthralgia and abdominal involvement.
  
  
  METHODS
  We report a case of a 50-year-old Caucasian man with tricuspid endocarditis caused by Tropheryma whipplei, showing signs of severe shock and an absence of other more classic clinical signs of Whipple's disease, such as arthralgia, abdominal pain and diarrhea. Tropheryma whipplei was documented by polymerase chain reaction of the blood and pleural fluid. The infection was treated with a combined treatment of doxycycline, hydroxychloroquine and sulfamethoxazole-trimethoprim for one year.
  
  
  CONCLUSIONS
  Tropheryma whipplei infectious endocarditis should always be considered when facing a blood-culture negative endocarditis particularly in right-sided valves. Although not standardized yet, treatment of Tropheryma whipplei endocarditis should probably include a bactericidal antibiotic (such as doxycycline) and should be given over a prolonged period of time (a minimum of one year).
authors.affiliation: Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland. vincent.gabus@chuv.ch.
authors.forename: Vincent
authors.initials: V
authors.lastname: Gabus
authors.forename: Zita
authors.initials: Z
authors.lastname: Grenak-Degoumois
authors.forename: Severin
authors.initials: S
authors.lastname: Jeanneret
authors.forename: Riana
authors.initials: R
authors.lastname: Rakotoarimanana
authors.forename: Gilbert
authors.initials: G
authors.lastname: Greub
authors.forename: Daniel
authors.initials: D
authors.lastname: Genné