BACKGROUND Whipple's disease (WD) is a rare multisystem infectious disorder that is caused by the actinomycete Tropheryma whipplei. It presents with joint pain followed by abdominal pain, diarrhea, malabsorption and finally failure to thrive. Diagnosis requires tissue sampling and histology with periodic acid-Schiff [PAS] staining. Thrombocytopenia associated with endocarditis associated with WD has been reported twice. CASE PRESENTATION A 56 year old Caucasian male presented with years of steroid treated joint pain and recent onset diarrhea, weight loss and abdominal pain. Ultimately he was found to have a platelet count of 4000 with concomitant endocarditis and embolic stroke. Small bowel biopsy confirmed the diagnosis of WD approximately 1 year after his first visit. His platelets improved with antibiotic treatment but he eventually expired 16 months after his initial consult and 5 months after his definitive diagnosis. CONCLUSION WD can remain undiagnosed and untreated until late in the course of the illness. A high index of suspicion is recognized as necessary for early diagnosis to begin treatment. Critical thrombocytopenia associated with endocarditis is a rare and potentially poor prognostic sign in late stage Whipple's disease.

中文翻译：

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Whipple病患者的血小板减少症和心内膜炎：病例报告。

背景技术Whipple病（WD）是由放线放线菌Tropheryma whipplei引起的罕见的多系统感染性疾病。它表现为关节痛，然后是腹痛，腹泻，吸收不良，最后无法壮成长。诊断需要组织采样和组织学检查，并用高碘酸席夫[PAS]染色。与WD相关的心内膜炎相关的血小板减少症已有两次报道。病例介绍一名56岁的白人男性，经多年类固醇激素治疗，出现关节疼痛，最近发作腹泻，体重减轻和腹痛。最终发现他的血小板计数为4000，并伴有心内膜炎和栓塞性中风。小肠活检首次访视大约一年后，确诊为WD。接受抗生素治疗后血小板有所改善，但最终在初次咨询后16个月和确诊5个月后死亡。结论直到疾病晚期，WD仍可被诊断和治疗。高怀疑度被认为是早期诊断开始治疗所必需的。与心内膜炎相关的严重血小板减少症是晚期Whipple病的一种罕见且可能不良的预后体征。