Relapse of Tropheryma whipplei endocarditis treated by trimethoprim/sulfamethoxazole, cured by hydroxychloroquine plus doxycycline

Stephane Emonet; Timothee Wuillemin; Stephan Harbarth; Nasstasja Wassilew; Mustafa Cikirikcioglu; Jacques Schrenzel; Jean-Christophe Lagier; Didier Raoult; Christian van Delden

doi:10.1016/j.ijid.2014.11.003

Relapse of Tropheryma whipplei endocarditis treated by trimethoprim/sulfamethoxazole, cured by hydroxychloroquine plus doxycycline

Int J Infect Dis. 2015 Jan:30:17-9. doi: 10.1016/j.ijid.2014.11.003. Epub 2014 Nov 6.

Authors

Stephane Emonet¹, Timothee Wuillemin², Stephan Harbarth³, Nasstasja Wassilew³, Mustafa Cikirikcioglu⁴, Jacques Schrenzel⁵, Jean-Christophe Lagier⁶, Didier Raoult⁶, Christian van Delden³

Affiliations

¹ Service of Infectious Diseases, Department of Medical Specialties, University Hospitals Geneva, Switzerland; Bacteriology laboratory, Department of Laboratories and Genetic Medicine, University Hospitals Geneva, Switzerland. Electronic address: [email protected].
² Internal Medicine Department, University Hospitals Geneva, Switzerland.
³ Service of Infectious Diseases, Department of Medical Specialties, University Hospitals Geneva, Switzerland.
⁴ Division of Cardiovascular Surgery, Department of Surgery, University Hospitals Geneva, Switzerland.
⁵ Service of Infectious Diseases, Department of Medical Specialties, University Hospitals Geneva, Switzerland; Bacteriology laboratory, Department of Laboratories and Genetic Medicine, University Hospitals Geneva, Switzerland.
⁶ Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, 13005 Marseille, France.

PMID: 25461667
DOI: 10.1016/j.ijid.2014.11.003

Abstract

The best treatment for Tropheryma whipplei infections is controversial. We report a patient who suffered from T. whipplei aortic native valve endocarditis that relapsed despite surgery and four weeks of intravenous ceftriaxone followed by several months of oral trimethoprim/sulfamethoxazole. Cure was achieved after replacement of the prosthesis with a homograft and 18 months of oral doxycycline-hydroxychloroquine. We discuss the need for a change in treatment guidelines for T. whipplei infections.

Keywords: Doxycycline; Endocarditis; Guidelines; Hydroxychloroquine; Trimethoprim/sulfamethoxazole; Whipple's disease.

Publication types

Case Reports

MeSH terms

Anti-Bacterial Agents / therapeutic use*
Aortic Valve* / microbiology
Ceftriaxone / therapeutic use
Doxycycline / therapeutic use*
Drug Therapy, Combination
Endocarditis, Bacterial / diagnosis
Endocarditis, Bacterial / drug therapy*
Heart Valve Diseases / diagnosis
Heart Valve Diseases / drug therapy*
Humans
Hydroxychloroquine / therapeutic use*
Male
Middle Aged
Recurrence
Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use
Tropheryma / isolation & purification
Whipple Disease / diagnosis
Whipple Disease / drug therapy*

Substances

Anti-Bacterial Agents
Hydroxychloroquine
Ceftriaxone
Trimethoprim, Sulfamethoxazole Drug Combination
Doxycycline