PMC8047165_01
Photomicrographs of cardiac vegetation. A, B Necrotic, fibrinous vegetation with numerous distended histiocytes (H&E, x4 and x40 respectively). C Intracellular organisms positive by Periodic acid-Schiff stain (x40); D Grocott methenamine silver stain showing smudgy, non-specific staining within histiocytes (x40); E, F Intracellular organisms negative by Brown and Brenn tissue gram stain and Ziehl-Neelsen stain (x40).
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A periodic acid-schiff (PAS) stain was then ordered, revealing numerous intracellular organisms with bacillary morphology, suggestive of Whipple's disease endocarditis (Fig. 1).