Abstract
Background: Whipple's disease (WD) is a rare, complex, multisystemic infection caused by Trophoryma whipplei (TW). Clinical diagnosis is challenging because of the low incidence rate, diversity of clinical manifestations, and lack of specificity in imaging examinations and routine laboratory tests.
Case presentation: We report a case of early central nervous system involvement in a patient with obesity and type II diabetes. After three days of fever and coughing, the patient’s condition aggravated with convulsive seizures and coma. Chest CT tomography revealed pulmonary inflammation, and brain Magnetic Resonance Imaging (MRI) were normal. The concentrations of chloride and sugar in the cerebrospinal fluid (CSF) were normal. The amount of cellular components was not significantly increased, but the protein level was slightly elevated. TW in bronchoalveolar lavage samples was confirmed using metagenomics next-generation sequencing (mNGS) after three weeks of meropenem combined with doxycycline and hormone treatment, and the patient’s symptoms were completely alleviated.
Conclusions: This case indicates that certain WD patients have early impairment of the central nervous system. If clinicians are aware of the presence of rare pathogenic bacterial infections and immediately apply mNGS for the early identification and treatment with targeted antibiotics, it can improve the prognosis of patients with WD.