Clinical and imaging characteristics of Whipple’s disease associated pneumonia

To analyze and summarize the clinical and imaging features of patients with pneumonia associated with Tropheryma Whipplei (TW), in order to enhance the understanding of pulmonary TW infection. Clinical and imaging data of eight patients with pulmonary TW infection admitted to our hospital from December 2020 to May 2024 were retrospectively reviewed. Among the eight patients with pulmonary TW infection, four were male and four were female, with a median age of 40 years (range, 33–60 years). Most patients had underlying diseases that associated with immune dysfunction, with AIDS and diabetes being the most common. Two patients had reduced peripheral white blood cell counts, and four patients had elevated C-reactive protein levels. Chest CT predominantly showed patchy infiltrates, ground-glass opacities, and nodular lesions. All eight patients were diagnosed by pathogen-targeted next-generation sequencing of bronchoalveolar lavage fluid. TW was the sole pathogen in two cases, while the remaining six cases had co-infections with other pathogens. All patients received antimicrobial therapy, and their clinical symptoms and imaging findings significantly improved after treatment. Pneumonia caused by TW often occurs secondary to immune dysfunction. Routine laboratory tests are insufficient for diagnosis, and chest CT shows various non-specific changes. Diagnosis is commonly confirmed by next-generation sequencing. Antimicrobial therapy can significantly improve the clinical condition.