Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2023; 11(25): 6019-6024
Published online Sep 6, 2023. doi: 10.12998/wjcc.v11.i25.6019
Diagnosis and treatment of Whipple disease after kidney transplantation: A case report
Qian Chen, Yu-Lin Niu, Tao Zhang
Qian Chen, Yu-Lin Niu, Tao Zhang, Department of Organ Transplantation, Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
Author contributions: Chen Q and Zhang T wrote and collated the manuscript; Niu YL and Chen Q collected and collated patient data, and Chen Q, Niu YL, and Zhang T reviewed and received funding for the manuscript. All authors contribute to the article and approve submitted versions.
Supported by Guiyang Science and Technology Program, No. 2019-9-1-39.
Informed consent statement: All authors have read the manuscript and agreed to its publication.
Conflict-of-interest statement: All authors declare that there is no conflict of interest in this study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tao Zhang, PhD, Chief Physician, Department of Organ Transplantation, Affiliated Hospital of Guizhou Medical University, No. 28 Guimedical Street, Yunyan District, Guiyang 550000, Guizhou Province, China. enric_olivera@sina.com
Received: July 6, 2023
Peer-review started: July 6, 2023
First decision: July 18, 2023
Revised: July 20, 2023
Accepted: August 1, 2023
Article in press: August 1, 2023
Published online: September 6, 2023
Processing time: 56 Days and 20.5 Hours
Abstract
BACKGROUND

Kidney transplantation is the standard treatment for end-stage renal disease. Particularly, rare and specific pathogenic infections which are asymptomatic are often difficult to diagnose, causing delayed and ineffective treatment and thus seriously affecting prognosis. Tropheryma whipplei (T. whipplei) is a Gram-positive actinomycete widely found in soil, sewage, and other external environments and is present in the population as an asymptomatic pathogen. There is relatively little documented research on T. whipplei in renal transplant patients, and there are no uniform criteria for treating this group of post-transplant patients. This article describes the treatment of a 42-year-old individual with post-transplant T. whipplei infection following kidney transplantation.

CASE SUMMARY

To analyze clinical features of Whipple’s disease and summarize its diagnosis and treatment effects after renal transplantation. Clinical data of a Whipple’s disease patient treated in the affiliated hospital of Guizhou Medical University were collected and assessed retrospectively. The treatment outcomes and clinical experience were then summarized via literature review. The patient was admitted to the hospital due to recurrent diarrhea for 1 mo, shortness of breath, and 1 wk of fever, after 3 years of renal transplantation. The symptoms of the digestive and respiratory systems were not significantly improved after adjusting immunosuppressive regimen and anti-diarrheal, empirical antibiotic treatments. Bronchoscopic alveolar fluid was collected for meta-genomic next-generation sequencing (mNGS). The deoxyribonucleic acid sequence of Tropheryma whipplei was detected, and Whipple’s disease was diagnosed. Meropenem, ceftriaxone, and other symptomatic treatments were given, and water-electrolyte balance was maintained. Symptoms resolved quickly, and the patient was discharged after 20 d of hospitalization. The compound sulfamethoxazole tablet was continued for 3 mo after discharge. No diarrhea, fever, and other symptoms occurred during the 6-month follow-up.

CONCLUSION

Whipple’s disease is rare, with no specific symptoms, which makes diagnosis difficult. Polymerase chain reaction or mNGS should be immediately performed when the disease is suspected to confirm the diagnosis.

Keywords: Kidney transplantation; Immunosuppression; Whipple disease; Whipple’s nutrient barrier; Macrogenomics second-generation sequencing technology; Case report

Core Tip: Whipple disease is rare and has no specific symptoms, which makes diagnosis difficult. When the disease is suspected, polymerase chain reaction or meta-genomic next-generation sequencing should be performed immediately to confirm the diagnosis.