ro13-9904 and Ischemia

Whipple's disease is known to cause multiple varied systemic symptoms, and is a well-documented cause of culture-negative endocarditis. Endocarditis secondary to Whipple disease, however, has rarely been known to present primarily as a cause of acute limb ischemia. We describe such a case here.. A previously healthy 40 year old man presented to the emergency department with acute-onset right arm paresthesias. On exam, he was found to be tachycardic with a VI/VI systolic ejection murmur. He was diagnosed with critical limb ischemia and severe aortic regurgitation, and echocardiography showed a large mass on his bicuspid aortic valve. Thrombectomy was performed urgently, with aortic valve repair the following day. As blood cultures and valvular tissue culture remained unrevealing, the patient remained on empiric vancomycin and ceftriaxone for culture-negative endocarditis. 16 s rRNA nucleic acid amplification testing (NAAT) of his formalin-fixed, paraffin-embedded valvular tissue detected T. whipplei, after which the patient was transitioned to ceftriaxone and trimethoprim-sulfamethoxazole for a year of therapy. He continues to do clinically well.. We report an unusual presentation of Whipple endocarditis as an acute upper limb ischemia, absent other classic symptoms of Whipple's disease, and with diagnosis made by 16 s rRNA NAAT of valvular tissue in the setting of culture-negative endocarditis.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Endocarditis, Bacterial; Humans; Ischemia; Male; Rare Diseases; Tropheryma; Whipple Disease

An elderly woman presented with very high levels of transaminases and lactic dehydrogenase in her liver function tests. Viral and drug-induced hepatitis were considered unlikely because of the absence of risk factors. Sepsis was suspected and antibiotic treatment was started with clinical improvement. A retrospective diagnosis of ischaemic hepatitis due to septicaemia was made. Markedly raised liver transaminases need not always be drug-induced or viral-related, especially in the elderly. It could be ischaemic in origin and the serious underlying condition needs to be sought and treated urgently.

Topics: Aged; Alanine Transaminase; Aspartate Aminotransferases; Bacteremia; Ceftriaxone; Cephalosporins; Female; Hepatitis; Humans; Ischemia; L-Lactate Dehydrogenase; Liver; Sepsis; Staphylococcal Infections