デキストロカルディア患者の心内膜炎を合併したWhipple病の1例

A rare case of Whipple's disease with endocarditis in a patient with dextrocardia.

• Abigayle Sullivan
• Pragya Shrestha
• Sijan Basnet
• Ronald Herb
• Emily Zagorski

抄録

症例は白人男性の高齢者であり，過去の病歴はdextrocardia with situs inversus totalis，多発性筋肉痛リウマチ性疾患，脳卒中の既往歴，重度の僧帽弁脱を伴う僧帽弁逆流症を有しており，多発性筋肉痛リウマチ性疾患と診断された1年前にステロイドによる免疫抑制下で，労作時の激しい呼吸困難，下肢浮腫の悪化などの急性心不全症状を呈した．本症例の1ヶ月前に一過性の虚血発作を発症し，検査中に経胸腔内心エコー検査では，重度の僧帽弁逆流を伴う後僧帽葉の筋腫性変性，部分的にフレイルを呈し，僧帽弁置換術を必要としていた．僧帽弁前葉病変のゲノムシークエンシングにより，培養陰性心内膜炎の原因菌として検出された．ceftriaxoneとampicillin-sulbactamを6週間投与し，さらにtrimethoprim-sulfamethoxazoleを1年間継続投与した．抗生物質による治療を継続したが，関節痛とともに息切れも消失した．

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 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.

© The Author(s) 2020.