Brondex A, Jobic Y
Service de cardiologie et pathologie vasculaire, hôpital d'instruction des armées Legouest, 27 avenue de Plantières, Metz, France.
Ann Cardiol Angeiol (Paris). 2012 Feb;61(1):61-3. doi: 10.1016/j.ancard.2010.12.005. Epub 2011 Jan 8.
Diagnosis of Whipple's disease is difficult, and thus its frequency is probably underestimated, particularly in culture-negative infective endocarditis. However, it must be systematically searched for in such a situation, first because it is associated with a poor natural outcome, and second because Tropheryma whipplei is not covered by the conventional empirical therapy recommended for culture-negative infective endocarditis. Whipple's disease endocarditis is usually associated with weight loss, intestinal and joint involvement. Nevertheless, it is sometimes the only manifestation of the disease, which makes the diagnosis much more difficult. We report the case of a 66-year-old patient with Barlow's disease, who underwent mitral valve replacement for severe mitral regurgitation. Vegetations were observed on the resected valve, both macroscopically and histologically. No microorganism was found at first. The diagnosis of Whipple's disease endocarditis was finally obtained by Polymerase Chain Reaction on valve tissue, and later confirmed by Periodic Acid Schiff staining. The outcome was favorable after a prolonged antibiotic therapy including doxycycline and hydroxychloroquine.
惠普尔病的诊断较为困难，因此其发病率可能被低估，在培养阴性的感染性心内膜炎中尤其如此。然而，在这种情况下必须进行系统排查，一是因为其预后较差，二是因为常规用于培养阴性感染性心内膜炎的经验性治疗方案并不涵盖惠普尔放线杆菌。惠普尔病性心内膜炎通常伴有体重减轻、肠道和关节受累。不过，它有时是该病的唯一表现，这使得诊断更加困难。我们报告一例66岁患有巴洛病的患者，因严重二尖瓣反流接受二尖瓣置换术。在切除的瓣膜上，肉眼和组织学检查均发现赘生物。起初未发现微生物。最终通过对瓣膜组织进行聚合酶链反应确诊为惠普尔病性心内膜炎，随后经高碘酸希夫染色得以证实。经过包括强力霉素和羟氯喹在内的长期抗生素治疗后，患者预后良好。
