Document Detail

Should we systematically perform central nervous system imaging in patients with Whipple's endocarditis?
MedLine Citation:
PMID:  20920700     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Whipple's endocarditis is an uncommon disease, with approximately 100 cases reported to date. Case series suggest that Whipple's endocarditis usually presents without extracardiac manifestations of Whipple's disease. METHODS: We report 4 consecutive cases of Whipple's endocarditis associated with brain lesions. All patients fulfilled Duke Criteria for definite endocarditis. Whipple's disease was diagnosed through 16S rRNA polymerase chain reaction assays on valves excised from patients with culture-negative endocarditis (n=3) or through polymerase chain reaction and periodic acid staining-positive foamy macrophages on duodenal biopsy (n=1). RESULTS: All patients were male, aged 56 to 72 years. They presented with mitral (n=1), aortic (n=1), mitral and aortic (n=1), and tricuspid (n=1) endocarditis. Brain magnetic resonance imaging was performed because of mild-to-moderate cognitive disorders (n=3) or ataxia (n=1) and revealed multiple (n=3) or solitary (n=1) contrast-enhancing lesions. Cerebrospinal fluid studies revealed meningitis in 1 case. Polymerase chain reaction assays on cerebrospinal fluid were negative for all patients. All patients received intravenous ceftriaxone (2-4 weeks) associated with gentamicin (2 weeks), followed by 1 year of oral trimethoprim-sulfamethoxazole, with favorable outcomes. CONCLUSION: Whipple's associated central nervous system disease may be common but frequently undiagnosed, in patients with Whipple's endocarditis. Because treatment is different when neurologic disease is present (ie, trimethoprim-sulfamethoxazole vs doxycycline/hydroxychloroquine), clinicians should consider brain imaging in patients diagnosed with Whipple's endocarditis.
Sophie Besnard; Anne Cady; Erwan Flecher; Fabien Fily; Matthieu Revest; Cédric Arvieux; Pierre-Yves Donnio; Christian Michelet; Pierre Tattevin
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  123     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-05     Completed Date:  2010-10-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  962.e1-4     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes Cedex, France.
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MeSH Terms
Brain / pathology
Central Nervous System Infections / complications,  diagnosis*,  pathology
Endocarditis, Bacterial / diagnosis*,  etiology,  pathology
Magnetic Resonance Imaging
Middle Aged
Whipple Disease / diagnosis*,  etiology,  pathology

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