Whipple's Disease Involving the Pericardium: Pathological Confirmation During Life

Abstract

Cardiac involvement in Whipple''s disease is a frequent autopsy finding but is rarely recognized clinically. A patient, a 63 yr old man, was reported in whom Whipple''s disease was diagnosed in 1974, based on a 7 yr history of arthralgia, 1 yr history of weight loss and steatorrhea and diagnostic small bowel biopsy. Despite complete regression of all joint and bowel symptoms following a prolonged course of tetracycline therapy, the patient developed incapacitating congestive heart failure and signs of constrictive pericarditis, for which a thoracotomy and pericardectomy was performed. Histologic examination revealed fibrous pericarditis with mononuclear infiltrates including PAS-positive histiocytes. The characteristic bacilliform bodies were identified by EM in the resected pericardium. This is the first demonstration of Whipple''s disease involving the living heart.