Severe and Rapid Progression of Tropheryma whipplei-Related Pneumonia With Septic Shock: A Case Report.

A 54-year-old Chinese male was admitted to our department with fever, vomiting and dyspnea. His condition rapidly worsened within 12 h with acute respiratory distress syndrome and septic shock. We performed routine laboratory tests and metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) and peripheral blood, the results of which indicated the presence of Tropheryma whipplei (TW) in BALF and no pathogens in peripheral blood. We treated him with mechanical ventilation, continuous renal replacement therapy (CRRT) for 3 days, and meropenem and trimethoprim/sulfamethoxazole (TMP/SMX), as well as other therapies for 12 days. The patient survived and showed clinical improvement, with chest computed tomography (CT) scan showing absorption of lesions. During the follow-up period, the patient was given oral TMP/SMX and cefdinir for up to 33 days, and the chest CT scan showing almost complete absorption of lesions. Clinicians should strengthen the awareness of the presence of severe TW-related pneumonia in a patient without immunodeficiency diseases. Rapid detection characteristics of mNGS can guide us to diagnose rare pathogenic bacteria and improve survival for those severe pneumonia patients.