Clinical characteristics of Tropheryma whipplei pneumonia: A retrospective analysis based on five cases.

OBJECTIVE: Acute pulmonary infection caused by Tropheryma whipplei (TW) is rare. This article summarizes the medical records of TW pneumonia patients to provide clinical insights into diagnosis and treatment. METHODS: A retrospective analysis was conducted on five patients diagnosed with TW pneumonia from 2021 to 2023 in Changzhou No. 2 People's Hospital. The study focused on clinical symptoms, imaging characteristics, diagnostic methods, and treatment approaches. RESULTS: Patients aged 35-65 years had underlying diseases and presented with fever, cough, expectoration, and chest tightness. Laboratory tests showed white blood cells, procalcitonin, C-reactive protein, and erythrocyte sedimentation rate increased, and the patients had anemia and hypoalbuminemia. Chest CT showed nodular lesions, cavities and patchy shadows. TW was detected in bronchoalveolar lavage fluid (BALF) by metagenomic next-generation sequencing (mNGS). Four patients received ceftriaxone combined with doxycycline or compound sulfamethoxazole tablets, while one treated empirically with cefotetan. All patients showed significant improvement. CONCLUSION: TW pneumonia often occurs in patients with underlying diseases, and immunocompromised patients have more severe lung damage. Most chest CT shows nodular lesions with atypical distribution and shape. Early diagnosis requires relies on mNGS, and treatment mainly bases on the third-generation cephalosporin combined with tetracycline or sulfonamides. Sequential therapy with sulfamethoxazole and clarithromycin is effective, and close follow-up needs to determine the total course of treatment.