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=Volume 13 - 2022

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=Whipple disease (WD) is a chronic multisystemic infection caused by Tropheryma whipplei. 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 Tropheryma whipplei. Electron microscopy allowed to discover an atypical bacterial organization present with a very large number of bacteria in the extracellular medium in vegetation and in valvular tissue. This atypical presentation we present here might be explained by the anti-inflammatory treatment administrated for our patient’s initial diagnosis of the rheumatoid arthritis.