分析惠普尔养障体(Tropheryma whipplei, T．whipplei)感染肺空洞结节患者临床资料并文献复习，旨在提高临床对惠普尔养障体肺部感染的认识。

归纳整理我院诊疗的1例惠普尔养障体肺部感染患者病例，包括患者病史、实验室检查结果、CT影像学表现、宏基因组二代测序(metagenomic next generation sequencing, mNGS)结果、诊疗经过、治疗效果等资料，结合惠普尔养障体肺部感染相关文献复习。

纳入患者为居住城区的青年女性，39岁；有猫科动物接触史。实验及辅助检查：白细胞6.35×10⁹/L、中性粒细胞绝对值3.5×10⁹/L、淋巴细胞绝对值2.02×10⁹/L、单核细胞绝对值0.58×10⁹/L、嗜酸性粒细胞0.21×10⁹/L、血红蛋白118 g/L、C-反应蛋白(C-reactive protein, CRP)0.4 mg/L；凝血四项：血浆凝血酶原时间(prothrombin time, PT)11.0 sec、活化部分凝血活酶时间(activated partial thromboplastin time, APTT)28.7 sec、凝血酶时间(thrombin time, TT)14.7 sec、纤维蛋白原(fibrinogen, FBG)2.45 g/L；肺泡灌洗液(bronchoalveolar lavage fluid, BALF)mNGS提示：G^＋菌：惠普尔养障体，序列数1179，相对丰度14.60%；真菌：似平滑念珠菌，序列数18相对丰度0.16%；DNA病毒：人类β疱疹病毒7型，序列数3，相对丰度2.12%。肺CT左下肺孤立性肺空洞结节为首发表现，经mNGS诊断为惠普尔养障体肺部感染，给予复方磺胺甲恶唑片口服3月规范抗感染治疗，肺空洞结节直径由18 mm×13 mm吸收缩小至11 mm×6 mm，治疗有效。

支气管肺泡灌洗液mNGS是确诊惠普尔养障体肺部感染的有效方法，临床上以肺空洞结节为唯一表现的非免疫抑制的患者需警惕惠普尔养障体感染，复方磺胺甲恶唑口服治疗效果显著。

To analyze the clinical data of one case with pulmonary cavitary nodule caused by Tropheryma whipplei(T.whipplei) infection and review the literature, aiming to improve the clinical understanding of pulmonary infection caused by T. whipplei.

A case of T. whipplei lung infection was reviewed and summarized, including the patient′s medical history, laboratory test results, CT imaging findings, metagenomic next generation sequencing (mNGS) results, treatment process, and therapeutic outcomes. The case was also compared with relevant literature on T. whipplei lung infections.

The study enrolled a female 39-year-old urban residents with a history of feline feline contact.Laboratory and auxiliary examinations revealed the following: white blood cell count 6.35×10⁹/L, absolute neutrophil count 3.5×10⁹/L, absolute lymphocyte count 2.02×10⁹/L, absolute monocyte count 0.58×10⁹/L, absolute eosinophil count 0.21×10⁹/L, hemoglobin 118 g/L, C-reactive protein (CRP) 0.4 mg/L. Coagulation panel: prothrombin time (PT) 11.0 sec, activated partial thromboplastin time (APTT) 28.7 sec, thrombin time (TT) 14.7 sec, fibrinogen (FBG) 2.45 g/L. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) indicated: Gram-positive bacteria: Tropheryma whipplei, sequence count 1179, relative abundance 14.60%; Fungus: Candida parapsilosis, sequence count 18, relative abundance 0.16%; DNA virus: Human betaherpesvirus 7, sequence count 3, relative abundance 2.12%. Chest CT showed a solitary cavitary nodule in the left lower lung as the initial presentation. The patient was diagnosed with Tropheryma whipplei pulmonary infection via mNGS and received a standardized 3-month course of oral cotrimoxazole (trimethoprim-sulfamethoxazole) anti-infective therapy. Following treatment, the cavitary nodule diameter decreased from 18 mm×13 mm to 11 mm×6 mm, indicating effective treatment response.

Bronchoalveolar lavage fluid mNGS is an effective diagnostic method for pulmonary infections caused by T. whipplei. Patients without immunosuppression who present solely with lung cavities or nodules should be vigilant for T. whipplei infection in clinical. Oral treatment with compound sulfamethoxazole has shown significant therapeutic effects.