Tropheryma whipplei in interstitial lung disease: A case series

IF 0.7 Q4 RESPIRATORY SYSTEM

Respiratory Medicine Case Reports Pub Date : 2025-01-01 DOI:10.1016/j.rmcr.2025.102279

Juan Li , Bingpeng Guo , Gui Zhao, Rui Wei, Qun Luo, Chao Zhuo, Qian Han

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Abstract

Introduction

Tropheryma whipplei (TW) is a bacterium associated with Whipple's disease (WD). It primarily affects the small intestine, heart and eyes, but some studies have explored its relationship with parenchymal disease. With technological advances, next-generation technology has enabled detection of TW in bronchoalveolar lavage (BALF),especially in patients with interstitial lung disease (ILD).

Case series

We describe three patients with ILD that was progressive, despite aggressive treatment. Next generation sequecning of BALF revealed the presence of TW, confirmed by polymerase chain reaction (PCR). Periodic acid-Schiff (PAS)-positive macrophages were identified in duodenal biopsy specimens from one patient. All three patients were prescribed doxycycline and hydroxychloroquine, as well as pharmacotherapy for ILD. During 3–6 months follow-up, TW was not detected in BALF and ILD was stable.

Conclusion

We report TW detection in BALF of 3 ILD patients, indicating its potential role as a disease-modifying pathogen in ILD progression. These cases underscore the impact of lung microbiome disturbances on ILD pathophysiology and highlight therapeutic implications.

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肺间质性疾病中的惠氏滋养瘤：一个病例系列

惠普尔滋养菌（TW）是一种与惠普尔病（WD）相关的细菌。它主要影响小肠、心脏和眼睛，但一些研究探讨了它与实质疾病的关系。随着技术的进步，新一代技术已经能够在支气管肺泡灌洗（BALF）中检测TW，特别是在间质性肺疾病（ILD）患者中。病例系列：我们描述了3例进展性ILD患者，尽管进行了积极治疗。下一代BALF测序显示TW的存在，经聚合酶链反应（PCR）证实。在一名患者的十二指肠活检标本中发现了周期性酸-希夫（PAS）阳性巨噬细胞。所有3例患者均给予强力西环素和羟氯喹以及ILD药物治疗。随访3 ~ 6个月，半衰期未发现TW， ILD稳定。结论我们报道了3例ILD患者的BALF中检测到TW，表明其在ILD进展中可能作为一种疾病修饰病原体。这些病例强调了肺微生物群紊乱对ILD病理生理的影响，并强调了治疗意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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