skip to main content

GPA (Non-Infectious Mimic) — SCE Infectious Diseases MCQ

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

HardRespiratory InfectionGPA (Non-Infectious Mimic)SCE Infectious Diseases

Valve 16S rRNA sequencing identifies Tropheryma whipplei in otherwise culture-negative aortic endocarditis. There is no CNS involvement. Which long-term oral regimen is listed by ESC?

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

Reveal the answer and explanation

Correct answer: D — Doxycycline 200 mg/day plus hydroxychloroquine 200–600 mg/day for at least 18 months

Explanation lettering: B = shown as A · C = shown as B · D = shown as C · E = shown as D · A = shown as E

E is correct. ESC lists doxycycline plus hydroxychloroquine for at least 18 months for T. whipplei endocarditis, acknowledging that evidence and optimal duration remain limited. The short doxycycline/gentamicin schedule is for Bartonella. A finite ceftriaxone-only course is inadequate, while trimethoprim alone is biologically unsound because trimethoprim is not active against T. whipplei. CNS involvement would additionally alter the regimen, including sulfadiazine. Long-term tolerability, hydroxychloroquine monitoring, relapse surveillance and Endocarditis-Team oversight are essential.

Reference: ESC 2023 guideline for the management of endocarditis: https://academic.oup.com/eurheartj/article/44/39/3948/7243107