Author + information
- Received August 24, 2013
- Revision received September 7, 2013
- Accepted September 10, 2013
- Published online March 18, 2014.
- Rony Lahoud, MD,
- Deborah H. Kwon, MD,
- Carmella D. Tan, MD and
- Allan L. Klein, MD
A 57-year-old Caucasian farmer presented with fatigue, weight gain, edema, dyspnea, orthopnea, and migratory arthralgias for 18 months. Physical exam was notable for fever, jugular venous distension, and a positive Kussmaul's sign. Transesophageal echocardiography showed mitral (A, arrow, Online Video 1) and tricuspid valve vegetations. Cardiac magnetic resonance imaging showed evidence of constrictive pericarditis with pericardial thickening and diastolic septal bounce (B, Online Video 2); delayed pericardial enhancement (C, arrow). Serum Whipple disease polymerase chain reaction result was positive.
He was initiated on trimethoprim/sulfamethoxazole + ceftriaxone and underwent pericardiectomy, mitral valve replacement, and tricuspid valve vegetation removal with subsequent symptomatic improvement. Pathology showed foamy macrophages in the valve tissue (D, arrow) and fibrotic pericardium (E) that are filled with periodic acid Schiff–positive organisms (F). Whipple disease is an important consideration in patients with exposure risk (such as soil exposure) and the appropriate constellation of symptoms.
- Received August 24, 2013.
- Revision received September 7, 2013.
- Accepted September 10, 2013.