Tropheryma whipplei in interstitial lung disease: A case series.

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.