We report a case of an elderly Caucasian male with past medical history of dextrocardiawith situs inversus totalis, polymyalgia rheumatica, history of cryptogenic stroke, andsevere mitral regurgitation with mitral valve prolapse, who presented with acute heartfailure symptoms, including severe dyspnea on exertion and worsening lower extremity edemain the setting of immunosuppression with steroids for a year-old diagnosis of polymyalgiarheumatica. One month prior to this presentation, the patient suffered a transientischemic attack and during the workup, his transthoracic echocardiography showedmyxomatous degeneration of posterior mitral leaflet, partially flail, with severe mitralregurgitation, which required mitral valve replacement. Genome sequencing of mitral valveanterior leaflet pathology detected Tropheryma whipplei as a causal agentof culture-negative endocarditis. The patient was treated with 6 weeks of ceftriaxone andampicillin–sulbactam and further continued trimethoprim–sulfamethoxazole for 1 year. Hecontinued antibiotic treatment with resolution of shortness of breath along witharthralgia.
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