We report a case of an elderly Caucasian male with past medical history of
dextrocardia with
situs inversus totalis,
polymyalgia rheumatica, history of
cryptogenic stroke, and severe
mitral regurgitation with
mitral valve prolapse, who presented with acute
heart failure symptoms, including severe
dyspnea on exertion and worsening lower extremity
edema in the setting of immunosuppression with
steroids for a year-old diagnosis of
polymyalgia rheumatica. One month prior to this presentation, the patient suffered a
transient ischemic attack and during the workup, his transthoracic echocardiography showed myxomatous degeneration of posterior mitral leaflet, partially flail, with severe
mitral regurgitation, which required mitral valve replacement. Genome sequencing of mitral valve anterior leaflet pathology detected Tropheryma whipplei as a causal agent of culture-negative
endocarditis. The patient was treated with 6 weeks of
ceftriaxone and
ampicillin-sulbactam and further continued
trimethoprim-sulfamethoxazole for 1 year. He continued
antibiotic treatment with resolution of
shortness of breath along with
arthralgia.