Ram Y. Gordon, MD; Emily Blumberg, MD; Susan C. Brozena, MD; Billie Fyfe, MD
Acknowledgments: The authors thank Marta Torres-Quinones for photographic support and Roberto Nicosia, MD, PhD, and James Diven for support of the ultrastructural analysis.
Gordon R., Blumberg E., Brozena S., Fyfe B.; Whipple Pancarditis as a Cause of Heart Failure. Ann Intern Med. 2004;140:673-674. doi: 10.7326/0003-4819-140-8-200404200-00036
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Published: Ann Intern Med. 2004;140(8):673-674.
TO THE EDITOR:
Background: Whipple disease is a rare disorder caused by infection with Tropheryma whippelii. We describe a patient who developed classic symptoms and eventual heart failure because of Whipple disease.
Case Report: Over a period of 5 years, a 38-year-old man developed frequent loose bowel movements, polyarthralgia, weight loss, edema, and finally dyspnea. On examination, he was thin and appeared ill, with jugular venous distention, a fourth heart sound, and edema. Echocardiography revealed normal left ventricular systolic function, mild right ventricular enlargement, abnormal diastolic septal motion, and a thickened pericardium. Cardiac catheterization revealed normal cardiac output and coronary arteries. A steep Y-descent was noted in the right atrial pressure tracing, and simultaneous recordings of right and left ventricular pressures showed elevation and equalization at end diastole, consistent with restrictive physiologic characteristics or constrictive pericardial disease. Right ventricular biopsy revealed nonspecific myocarditis.
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