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Published on: October 5, 2015
Tropheryma whipplei in interstitial lung disease: A case series
Juan Li1, Bingpeng Guo1, Gui Zhao1
1State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
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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