Pulmonary infection caused by Tropheryma whipplei: a case report and review of the literature

Abstract

Background: Tropheryma whipplei pneumonia is an infrequent medical condition. The clinical symptoms associated with this disease are nonspecific, often resulting in misdiagnosis or missed diagnosis. Therefore, sharing and summarizing the experiences in the diagnosis and treatment of this disease can deepen global understanding and awareness of it.

Case presentation: The patient is a 78-year-old married Han Chinese female who was admitted to the hospital after experiencing fever, dry cough, and fatigue for 4 days. A lung computed tomography scan revealed inflammatory exudation in the lower left lung, accompanied by pleural effusion. The bronchoalveolar lavage fluid was subjected to further analysis using metagenomic next-generation sequencing, which identified 41 genetic sequences associated with Tropheryma whipplei. Consequently, she was diagnosed with Tropheryma whipplei pneumonia. After initiating treatment with doxycycline and biapenem, the patient's symptoms showed significant improvement. Upon discharge, the patient continued treatment with a combination of doxycycline and hydroxychloroquine, which was discontinued after 4 days. At 12-month follow-up, the patient reported overall good health, with no symptoms of fever, cough, or any other discomfort.

Conclusion: Tropheryma whipplei pneumonia is a rare condition with nonspecific symptoms. The application of metagenomic next-generation sequencing technology in pulmonary infections helps to rapidly identify rare pathogens, providing a solid foundation for precise and effective antibacterial treatment for patients.

Keywords: Tropheryma whipplei; Case report; Pneumonia; Whipple’s disease.

Fig. 1

Chest computed tomography scan of the patient. The dates from left to right are 15 September 2021 (A), 23 September 2021 (B), and 29 September 2021 (C)

Fig. 2

Fiberoptic bronchoscopy of the patient: trachea carina (A), superior lobe of right lung (B), middle segmental bronchus of right lung (C), middle lobe of right lung (D), lower lobe of right lung (E), inherent superior lobe of left lung (F), and lingual lobe of left lung (G)