AUTHOR=Hannachi Nadji , Arregle Florent , Lepidi Hubert , Baudoin Jean-Pierre , Gouriet Frédérique , Martel Hélène , Hubert Sandrine , Desnues Benoit , Riberi Alberto , Casalta Jean-Paul , Habib Gilbert , Camoin-Jau Laurence 

TITLE=A Massive Number of Extracellular Tropheryma whipplei in Infective Endocarditis: A Case Report and Literature Review

JOURNAL=Frontiers in Immunology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.900589

DOI=10.3389/fimmu.2022.900589

ISSN=1664-3224

ABSTRACT=<p>Whipple’s disease (WD) is a chronic multisystemic infection caused by <italic>Tropheryma whipplei</italic>. If this bacterium presents an intracellular localization, associated with rare diseases and without pathognomonic signs, it is often subject to a misunderstanding of its physiopathology, often a misdiagnosis or simply an oversight. Here, we report the case of a patient treated for presumed rheumatoid arthritis. Recently, this patient presented to the hospital with infectious endocarditis. After surgery and histological analysis, we discovered the presence of <italic>T. whipplei</italic>. Electron microscopy allowed us to discover an atypical bacterial organization with a very large number of bacteria present in the extracellular medium in vegetation and valvular tissue. This atypical presentation we report here might be explained by the anti-inflammatory treatment administrated for our patient’s initial diagnosis of rheumatoid arthritis.</p>