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Cardiac Whipple Disease: Identification of Whipple Bacillus by Electron Microscopy in the Myocardium of a Patient before Death

Frank E. Silvestry, MD; Back Kim, MD; Bonnie J. Pollack, MD; Julia E. Haimowitz, MD; Richard K. Murray, MD; Emma E. Furth, MD; Harvey L. Nisenbaum, MD; Michael L. Kochman, MD; Neil Freedman, MD; Rogelio Pine, MD; and Howard C. Herrmann, MD
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From the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Princeton Medical Center, Princeton, New Jersey. Requests for Reprints: Howard C. Herrmann, MD, Cardiovascular Division, University of Pennsylvania Medical Center, 9 Founder's Pavilion, 3400 Spruce Street, Philadelphia, PA 19104. Current Author Addresses: Drs. Silvestry and Herrmann: Cardiovascular Division, University of Pennsylvania Medical Center, 9 Founder's Pavilion, 3400 Spruce Street, Philadelphia, PA 19104.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;126(3):214-216. doi:10.7326/0003-4819-126-3-199702010-00006
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Whipple disease was first described in 1907 in a 36-year-old patient with diarrhea, abdominal pain, weight loss, and polyarthritis [1]. The causative agent, now called Tropheryma whippelii, is closely related to the actinomycetes [2]. Whipple disease usually affects the intestinal tract but may involve other organ systems, including pulmonary and neurologic tissue [34]. Macrophages that yield positive results on periodic acid-Schiff staining are characteristically seen in the lamina propria of the small bowel, and electron microscopy shows rod-shaped bacillary bodies that are believed to be the causative agent.

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Figure 1.
Right ventricular myocardial biopsy specimen viewed by light microscopy.arrows

Disordered myofibrils and numerous bacilli can be seen ( ) (periodic acid-Schiff; original magnification, x100).

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Figure 2.
Myocardial biopsy specimen taken before death, viewed by electron microscopy.arrow

Whipple bacillus is evident ( ) (original magnification, x15 000).

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