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

Tropheryma whipplei (T. whipplei) is 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 T. whipplei infection. Several studies have indicated an association between T. whipplei infection and immunocompromised conditions; however, a few studies have also revealed that aspiration may be a potential predisposing factor for T. whipplei-related aspiration pneumonia. This case study reports two different cases of aspiration-induced T. whipplei 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 T. whipplei pneumonia. However, in one case, the patient suffered from a severe co-infection of T. whipplei and Aspergillus following a drowning incident, which was effectively treated with meropenem and voriconazole co-therapy. This study provides novel data on T. whipplei infection and improves clinical awareness of aspiration-related pneumonia.