Case Report: Whipple’s disease pneumonia caused by inhalation of gas or liquid

<i>Tropheryma whipplei</i> (<i>T. whipplei</i>) <i>i</i>s a Gram-positive bacterium that causes rare clinical infections, which primarily manifest as gastrointestinal infections and, more rarely, pulmonary diseases. Furthermore, immunosuppression is considered a predominant risk factor for <i>T. whipplei</i> infection. Several studies have indicated an association between <i>T. whipplei</i> infection and immunocompromised conditions; however, a few studies have also revealed that aspiration may be a potential predisposing factor for <i>T. whipplei-</i>related aspiration pneumonia. This case study reports two different cases of aspiration-induced <i>T. whipplei</i> pneumonia, each exhibiting unique clinical manifestations, imaging features, and therapeutic responses. Both patients had a history of aspiration, and their diagnoses were confirmed via mNGS. They were treated with sulfamethoxazole-trimethoprim (SMZ), which effectively alleviated the symptoms of mild <i>T. whipplei</i> pneumonia. However, in one case, the patient suffered from a severe co-infection of <i>T. whipplei</i> and <i>Aspergillus</i> following a drowning incident, which was effectively treated with meropenem and voriconazole co-therapy. This study provides novel data on <i>T. whipplei</i> infection and improves clinical awareness of aspiration-related pneumonia.