skip to main content

Whipple Endocarditis — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

HardBone & Joint InfectionWhipple EndocarditisSCE Infectious Diseases

A 48-year-old woman with a bioprosthetic mitral valve develops culture-negative endocarditis. Extensive serological workup is negative. TOE shows a 12 mm vegetation. She undergoes valve replacement. The excised valve tissue is sent for 16S ribosomal RNA PCR. This detects Tropheryma whipplei. What is the recommended treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — IV Ceftriaxone 2 g daily for 2 weeks then oral Co-trimoxazole 960 mg BD for at least 12 months

Whipple disease endocarditis is a rare but important cause of culture-negative endocarditis. Diagnosis typically requires PCR or immunohistochemistry on valve tissue or blood. Treatment follows the same principles as systemic Whipple disease: IV Ceftriaxone (or Meropenem) for 2 weeks induction to achieve CNS penetration, followed by oral Co-trimoxazole 960 mg BD for at least 12 months. Doxycycline plus Hydroxychloroquine is an alternative maintenance regimen. Relapse monitoring with serial PCR is essential.

Reference: ESC 2023 – Endocarditis guidelines; European guidelines 2019 – Tropheryma whipplei