MYOCARDITIS IN WHIPPLES-DISEASE - AN UNSUSPECTED CAUSE OF SYMPTOMS AND SUDDEN-DEATH

Whipple's disease (WD) is an uncommonly diagnosed infection caused by the recently characterized bacillus, Tropheryma whippelii. The associa tion of WD with pericarditis and endocarditis is widely recognized, al though less attention has been paid to the myocardium as a site of dis ease, Although the disease was uniformly fatal before antibiotic thera py, current treatment usually results in cure, We report two patients whose deaths were directly related to cardiac involvement by WD and wh ose underlying disease escaped diagnosis for years. The first, a 60-ye ar-old white woman, suffered a cardiovascular collapse, and lymphocyti c myocarditis was demonstrated at autopsy, The second, a 48-year-old b lack man, had a lengthy history of progressive cardiac failure that te rminated in arrhythmia. Extensive myocardial fibrosis, with lymphocyti c and granulomatous inflammation, was demonstrated at autopsy, The pre sence of T. whippelii was confirmed by electron microscopic examinatio n in both cases and by polymerase chain reaction in one, Patients with WD might harbor an undiagnosed lymphocytic or granulomatous myocardit is, and this diagnosis should be considered in the evaluation of cardi ac failure.