以胸痛为首发症状的惠普尔养障体肺部感染1例及文献回顾

Tropheryma whipplei Pulmonary Infection with Chest Pain as the First Symptom: A Case Report and Literature Review

摘要: 惠普尔养障体(Tropheryma whipplei, TW)是一种革兰氏阳性放线菌，广泛存在于土壤、污水和外部环境中，同时以无症状病原体存在于人群中，属于条件致病菌。惠普尔病(Whipple disease, WD)是由TW感染引起的罕见的复杂性多系统损害性疾病，其主要影响消化系统、关节、神经系统及心血管系统。TW引起的肺部感染临床少见，其发病机制尚不明确，诊疗思路亦尚未统一。国内外关于TW肺炎的相关研究非常少，随着宏基因组下一代测序(Metagenomic next generation sequencing, mNGS)的普及，TW引发的肺部感染病例发现率较前有所增加。TW引发的WD具有临床症状不典型、病情进展迅速、死亡率高等特点，因此早期识别并规范化诊疗对于改善TW感染患者预后具有重要意义。本研究回顾性分析1例以间断胸痛为首发表现的TW肺部感染患者的临床资料，旨在为临床医师提供一定诊疗思路，现报道如下。

Abstract: Tropheryma whipplei (TW) is a Gram-positive actinomycete that is widely present in soil, sewage and external environment, and also exists in humans as an asymptomatic pathogen. Whipple disease (WD) is a rare complex multi-system damaging disease caused by TW infection, which mainly affects the digestive system, joints, nervous system and cardiovascular system. Pulmonary infection caused by TW is rare in clinic, its pathogenesis is not clear, and the diagnosis and treatment ideas have not been unified. There are very few relevant studies on TW pneumonia at home and abroad. With the popularization of metagenomic next generation sequencing (mNGS), the detection rate of pulmonary infection caused by TW has increased. WD caused by TW is characterized by atypical clinical symptoms, rapid disease progression, and high mortality. Therefore, early identification and standardized diagnosis and treatment are of great significance for improving the prognosis of TW infected patients. This study retrospectively analyzed the clinical data of a case of TW pulmonary infection with intermittent chest pain as the first manifestation, aiming to provide certain diagnosis and treatment ideas for clinicians. The report is as follows.