Circulation, Vol 52, 722-731, Copyright © 1975 by American Heart Association
TN James and WS Haubrich
Although Whipple's disease is clinically recognized for its features of
arthritis and diarrhea, pericarditis and cardiac valvular disease are
frequently present and a significant number of such patients die suddenly
and unexpectedly. This report includes special postmortem cardiovascular
examinations in a 55-year-old man who died of Whipple's disease.
Pericarditis and valvular disease were extensively present. There was also
focal myocardial degeneration, including the sinus node, A-V node and His
bundle. Typical Schiff-positive bacilli were found in the tunica media and
endothelium most numerously in the small coronary and hepatic arteries,
less in splenic and renal arteries, and least in small pulmonary arteries.
Large coronary arteries and the aorta were not involved. Three stages of
bacterial invasion of the arteries included a noninflammatory phase in
which the bacilli were most numerous, a pancreatic phase in which bacilli
were distinctly less numerous, and a healed scarring of arteries previously
damaged. The combination of pericarditis, valvular disease of the heart,
coronary and systemic bacterial arteritis and focal myocardial degeneration
and myocarditis is unusual for Whippl'e disease. Studies of other cases are
warranted to determine whether bacterial arteriopathy and arteritis have
previously been overlooked or if the present case is unique. Evidence that
the conduction system of the heart may be involved indicated that careful
attention to cardiac rhyth and conduction is merited in future studies of
patients with Whipple's disease.
ARTICLES
De subitaneis mortibus. XIV. Bacterial arteritis in Whipple's disease