Case Presentation
A 60-year-old male with multiple medical including CLL, type 2 Diabetes
Mellitus, hyperlipidemia, prostate cancer, and tobacco abuse, presented
to the VA ED complaining of difficulty speaking and left arm weakness.
No cardiac murmur was appreciated on physical exam and no focal
neurologic deficits. Workup revealed a left parietal ischemic infarct.
Further workup with Transthoracic Echocardiography revealed a trileaflet
aortic valve with mild leaflet thickening and a calcified mobile mass on
the aortic valve leaflets measuring 1.4 cm. Evaluation with
Transesophageal Echocardiogram confirmed the mass. Cardiac surgery was
consulted for a suspected fibroelastoma. There was low suspicion for
endocarditis with no evidence of a systemic infection. The mass was
excised for histopathological evaluation consistent with a Calcified
Amorphous Tumor (Fig. 1). However, 16s rRNA and 18s rRNA sequencing
detected Tropheryma whipplei, and the diagnosis of Whipple’s
endocarditis was made.