{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T10:36:52Z","timestamp":1770460612956,"version":"3.49.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T00:00:00Z","timestamp":1656460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Whipple\u2019s disease (WD) is a chronic multisystemic infection caused by <jats:italic>Tropheryma whipplei<\/jats:italic>. If this bacterium presents an intracellular localization, associated with rare diseases and without pathognomonic signs, it is often subject to a misunderstanding of its physiopathology, often a misdiagnosis or simply an oversight. Here, we report the case of a patient treated for presumed rheumatoid arthritis. Recently, this patient presented to the hospital with infectious endocarditis. After surgery and histological analysis, we discovered the presence of <jats:italic>T. whipplei<\/jats:italic>. Electron microscopy allowed us to discover an atypical bacterial organization with a very large number of bacteria present in the extracellular medium in vegetation and valvular tissue. This atypical presentation we report here might be explained by the anti-inflammatory treatment administrated for our patient\u2019s initial diagnosis of rheumatoid arthritis.<\/jats:p>","DOI":"10.3389\/fimmu.2022.900589","type":"journal-article","created":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T06:11:07Z","timestamp":1656483067000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["A Massive Number of Extracellular Tropheryma whipplei in Infective Endocarditis: A Case Report and Literature Review"],"prefix":"10.3389","volume":"13","author":[{"given":"Nadji","family":"Hannachi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florent","family":"Arregle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hubert","family":"Lepidi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Pierre","family":"Baudoin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fr\u00e9d\u00e9rique","family":"Gouriet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e9l\u00e8ne","family":"Martel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandrine","family":"Hubert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benoit","family":"Desnues","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Riberi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Paul","family":"Casalta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilbert","family":"Habib","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurence","family":"Camoin-Jau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1056\/NEJMra062477","article-title":"Whipple\u2019s Disease","volume":"356","author":"Fenollar","year":"2007","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3201\/eid1911.121356","article-title":"Tropheryma Whipplei Endocarditis","volume":"11","author":"Fenollar","year":"2013","journal-title":"Emerg Infect Dis"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000008392","article-title":"Blood Culture-Negative Endocarditis: Improving the Diagnostic Yield Using New Diagnostic Tools","volume":"96","author":"Fournier","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1086\/422845","article-title":"Cardiac Valves in Patients With Whipple Endocarditis: Microbiological, Molecular, Quantitative Histologic and Immunohistochemical Studies of 5 Patients","volume":"190","author":"Lepidi","year":"2004","journal-title":"J Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv319","article-title":"2015 ESC Guidelines for the Management of Infective Endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). 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