Short-Term Amoxicillin Clavulanate in the Treatment of Pulmonary Abscess Caused by Tropheryma whipplei Infection Diagnosed by Targeted Next-Generation Sequencing: A Case Report and Literature Review.

Background: Tropheryma whipplei (T. whipplei) is a rod-shaped, Gram-positive, acid-fast bacterium. Classical Whipple's disease, a rare chronic infectious condition affecting multiple systems, is traditionally attributed to T. whipplei infection. The conventional treatment regimen consists of a one-year course of oral doxycycline (100 mg twice daily) and hydroxychloroquine (600 mg daily), followed by lifelong doxycycline maintenance therapy. However, the literature lacks discussion on short-term antimicrobial treatment for acute T. whipplei infections, such as pulmonary abscesses caused by this pathogen.

Presentation: This case report describes a 57-year-old male presenting with a pulmonary abscess. The patient underwent bronchoscopic alveolar lavage and pus cavity irrigation. The collected sample was subjected to pathogen targeted next-generation sequencing (tNGS) analysis. The tNGS results indicated that T. whipplei was the primary etiological agent responsible for the pulmonary abscess. Treatment with 6 weeks amoxicillin clavulanate led to a favorable clinical outcomes.

Conclusion: Existing case reports typically employ treatment protocols for classic Whipple's disease, such as oral doxycycline combined with hydroxychloroquine or trimethoprim/sulfamethoxazole for a one-year duration. The use of amoxicillin/clavulanic acid for short-term antimicrobial treatment of T. whipplei-induced pulmonary abscesses achieved favorable clinical outcomes. This case study explores the feasibility of short-term antimicrobial therapy for an acute T. whipplei infection.