title: Tropheryma whipplei bivalvular endocarditis and polyarthralgia: a case report.
abstract: BACKGROUND
  Tropheryma whipplei infection should be considered in patients with suspected infective endocarditis with negative blood cultures. The case (i) shows how previous symptoms can contribute to the diagnosis of this illness, and (ii) elucidates current recommended diagnostic and therapeutic approaches to Whipple's disease.
  
  
  METHODS
  A 71-year-old Swiss man with a past history of 2 years of diffuse arthralgia was admitted for a possible endocarditis with severe aortic and mitral regurgitation. Serial blood cultures were negative. Our patient underwent replacement of his aortic and mitral valve by biological prostheses. T. whipplei was documented by polymerase chain reactions on both removed valves and on stools, as well as by valve histology. A combination of hydroxychloroquine and doxycycline was initiated as lifetime treatment followed by the complete disappearance of his arthralgia.
  
  
  CONCLUSIONS
  This case report underlines the importance of considering T. whipplei as a possible causal etiology of blood culture-negative endocarditis. Lifelong antibiotic treatment should be considered for this pathogen (i) due to the significant rate of relapses, and (ii) to the risk of reinfection with another strain since these patients likely have some genetic predisposition.
authors.affiliation: Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 11, 1011, Lausanne, Switzerland. rivasjanina@gmail.com.
authors.forename: Janina Rivas
authors.initials: JR
authors.lastname: Gruber
authors.affiliation: Institute of Pathology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue de Bugnon 25, 1011, Lausanne, Switzerland. rossella.sarro@chuv.ch.
authors.forename: Rossella
authors.initials: R
authors.lastname: Sarro
authors.affiliation: Infectious Disease Service, Centre Hospitalier Universitaire Vaudois (CHUV), Rue de Bugnon 48, 1011, Lausanne, Switzerland. julie.delaloye@chuv.ch.
authors.forename: Julie
authors.initials: J
authors.lastname: Delaloye
authors.affiliation: Cabinet de Cardiologie, Rue des Charpentiers 9, 1110, Morges, Switzerland. j-f.surmely@bluewin.ch.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Surmely
authors.affiliation: Service of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue de Bugnon 46, 1011, Lausanne, Switzerland. giuseppe.siniscalchi@chuv.ch.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Siniscalchi
authors.affiliation: Service of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue de Bugnon 46, 1011, Lausanne, Switzerland. piergiorgio.tozzi@chuv.ch.|Service of Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. piergiorgio.tozzi@chuv.ch.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Tozzi
authors.affiliation: Cabinet Medical, Avenue de Florimont 8, 1006, Morges, Switzerland. cyla.jaques@bluewin.ch.
authors.forename: Cyril
authors.initials: C
authors.lastname: Jaques
authors.affiliation: Institute of Microbiology, University of Lausanne, Rue de Bugnon 48, 1011, Lausanne, Switzerland. Katia.Jaton-Ogay@chuv.ch.
authors.forename: Katia
authors.initials: K
authors.lastname: Jaton
authors.affiliation: Service of Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. alain.delabays@chuv.ch.
authors.forename: Alain
authors.initials: A
authors.lastname: Delabays
authors.affiliation: Infectious Disease Service, Centre Hospitalier Universitaire Vaudois (CHUV), Rue de Bugnon 48, 1011, Lausanne, Switzerland. gilbert.greub@chuv.ch.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Greub
authors.affiliation: Service of Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. tobias.rutz@chuv.ch.
authors.forename: Tobias
authors.initials: T
authors.lastname: Rutz
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery; D018771:Arthralgia / Q000150:complications*; D004318:Doxycycline / Q000627:therapeutic use; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D016133:Polymerase Chain Reaction; D054851:Tropheryma; D008061:Whipple Disease / Q000188:drug therapy* / Q000473:pathology*
chemical_list: D000900:Anti-Bacterial Agents; D006886:Hydroxychloroquine; D004318:Doxycycline