Abstract
INTRODUCTION: Infective endocarditis is a rare complication of untreated Whipple's disease. We present a case of infective endocarditis caused by Tropheryma whipplei in an aortic bioprosthesis. CASE PRESENTATION: A 77-year-old man with a bioprosthetic aortic valve and pacemaker presented with two months of fever. He had a history of HLA-B27-negative ankylosing spondylitis treated with adalimumab. Examination revealed a systolic aortic murmur. Transthoracic echocardiography revealed vegetation on the aortic bioprosthetis. Serologies and cultures were negative. He underwent valve replacement, endocavitary pacemaker system removal, and epicardial pacemaker implantation. Valve tissue PCR and 16S rRNA sequencing were positive for T. whipplei. Empiric ceftriaxone was given for two weeks, followed by doxycycline and hydroxychloroquine for 12 months, then lifelong doxycycline monotherapy. CONCLUSION: Whipple's endocarditis is difficult to diagnose due to its atypical presentation and frequent failure to meet Duke criteria. Tissue PCR plays a crucial role when standard microbiologic testing is inconclusive.