Hongyuan Zhou,* Jian Zhang* 

Department of Respiratory and Critical Care Medicine, Yuyao People’s Hospital, Ningbo City, Zhejiang Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jian Zhang, Department of Respiratory and Critical Care Medicine, Yuyao People’s Hospital, No. 800 Chengdong Road, Fengshan District, Ningbo City, Zhejiang Province, People’s Republic of China, Tel +8615068756296, Email 514041632@qq.com

Background: Tropheryma whipplei (T. whipplei) is a rod-shaped, Gram-positive, acid-fast bacterium. Classical Whipple’s disease, a rare chronic infectious condition affecting multiple systems, is traditionally attributed to T. whipplei infection. The conventional treatment regimen consists of a one-year course of oral doxycycline (100 mg twice daily) and hydroxychloroquine (600 mg daily), followed by lifelong doxycycline maintenance therapy. However, the literature lacks discussion on short-term antimicrobial treatment for acute T. whipplei infections, such as pulmonary abscesses caused by this pathogen.
Presentation: This case report describes a 57-year-old male presenting with a pulmonary abscess. The patient underwent bronchoscopic alveolar lavage and pus cavity irrigation. The collected sample was subjected to pathogen targeted next-generation sequencing (tNGS) analysis. The tNGS results indicated that T. whipplei was the primary etiological agent responsible for the pulmonary abscess. Treatment with 6 weeks amoxicillin clavulanate led to a favorable clinical outcomes.
Conclusion: Existing case reports typically employ treatment protocols for classic Whipple’s disease, such as oral doxycycline combined with hydroxychloroquine or trimethoprim/sulfamethoxazole for a one-year duration. The use of amoxicillin/clavulanic acid for short-term antimicrobial treatment of T. whipplei-induced pulmonary abscesses achieved favorable clinical outcomes. This case study explores the feasibility of short-term antimicrobial therapy for an acute T. whipplei infection.

Keywords: Tropheryma whipplei, pulmonary abscess, tNGS, bronchoscopic lavage