BACKGROUND Whipple's disease is a clinically relevant multi-system disorder that is often undiagnosed given its elusive nature. We present an atypical case of Whipple's disease involving pan-valvular endocarditis and constrictive pericarditis, requiring cardiac intervention. A literature review was also performed assessing the prevalence of atypical cases of Whipple's disease. CASE PRESENTATION A previously healthy 56-year-old male presented with a four-year history of congestive heart failure with weight loss and fatigue. Notably, he had absent gastrointestinal symptoms. He went on to develop pan-valvular endocarditis and constrictive pericarditis requiring urgent cardiac surgery. A clinical diagnosis of Whipple's disease was suspected, prompting duodenal biopsy sampling which was unremarkable, Subsequently, Tropheryma whipplei was identified by 16S rDNA PCR on the cardiac valvular tissue. He underwent prolonged antibiotic therapy with recovery of symptoms. CONCLUSIONS Our study reports the first known case of Whipple's disease involving pan-valvular endocarditis and constrictive pericarditis. A literature review also highlights this presentation of atypical Whipple's with limited gastrointestinal manifestations. Duodenal involvement was limited and the gold standard of biopsy was not contributory. We also highlight the Canadian epidemiology of the disease from 2012 to 2016 with an approximate 4% prevalence rate amongst submitted samples. Routine investigations for Whipple's disease, including duodenal biopsy, in this case may have missed the diagnosis. A high degree of suspicion was critical for diagnosis of unusual manifestations of Whipple's disease.

中文翻译：

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另一个Whipple的三合会？从加拿大的角度来看，心包，心肌和瓣膜疾病是一种不寻常的病例表现。

背景技术Whipple病是一种临床相关的多系统疾病，鉴于其难以捉摸的性质，通常无法诊断。我们提出了一种非典型的Whipple病，涉及泛瓣膜性心内膜炎和缩窄性心包炎，需要心脏干预。还进行了文献综述，以评估非典型的Whipple病病例的患病率。病例介绍一名先前健康的56岁男性，具有4年充血性心力衰竭，体重减轻和疲劳的病史。值得注意的是，他没有胃肠道症状。他继续发展需要紧急心脏手术的全瓣膜心内膜炎和缩窄性心包炎。怀疑有Whipple病的临床诊断，促使进行了十二指肠活检，但效果不显着。通过心脏瓣膜组织上的16S rDNA PCR鉴定了惠氏壶菌。他接受了长期的抗生素治疗，症状得以恢复。结论我们的研究报告了首例Whipple病，涉及泛瓣膜性心内膜炎和缩窄性心包炎。文献综述还强调了这种胃肠道表现有限的非典型Whipple病的表现。十二指肠受累是有限的，活检的黄金标准没有贡献。我们还重点介绍了2012年至2016年该疾病的加拿大流行病学，提交样本中的患病率约为4％。在这种情况下，常规的Whipple病检查（包括十二指肠活检）可能无法诊断。