Tropheryma whipplei Infection Presenting Initially with Chest Pain

BACKGROUND: Tropheryma whipplei is a rare pathogenic bacterium, a Gram-positive actinomycete widely distributed in the natural environment. It mainly infects individuals with immunodeficiency, but is rarely observed in individuals with normal immune function. Most patients present with non-specific symptoms, and since it is not feasible to culture the bacteria using conventional methods, diagnosing this infection is very difficult. In this case, next-generation sequencing (NGS) detection via bronchoscopy confirmed the final diagnosis of Tropheryma whipplei infection. METHODS: Bronchoscopy and next-generation sequencing were used. RESULTS: Through bronchoscopy, NGS of bronchoalveolar lavage fluid indicated the presence of Tropheryma whipplei. Therefore, anti-infective treatment was administered. CONCLUSIONS: For cases of long-standing chest pain of unknown origin with abnormal findings on chest imaging, it is crucial to stabilize the patient's condition while identifying the underlying cause. Prompt implementation of relevant diagnostic procedures, such as bronchoscopy, is essential for establishing a diagnosis.