Clinically Suspected Whipple Disease Presenting with Acute Kidney Injury as the Initial Manifestation and Complicated by Severe Pneumonia Requiring Veno-Venous Extracorporeal Membrane Oxygenation

Background: Whipple disease (WD) is a chronic, multisystem infectious disorder caused by the Gram-positive bacterium Tropheryma whipplei ( T. whipplei ). Classical presentations most commonly include intermittent arthralgia or arthritis, often accompanied by chronic gastrointestinal symptoms such as abdominal pain and diarrhea. Owing to its broad clinical spectrum and the absence of pathognomonic features, early diagnosis remains challenging. Case Report: This report describes a patient with T. whipplei infection who presented with acute kidney injury as the initial and predominant manifestation, an uncommon presentation of WD. The clinical course rapidly progressed to severe pneumonia and severe acute respiratory distress syndrome, necessitating veno-venous extracorporeal membrane oxygenation (ECMO) support. Following intensive management, renal function showed gradual improvement, evidenced by increased urine output and a reduction in serum creatinine levels, while chest imaging demonstrated mild radiological improvement. Despite these findings, the patient subsequently died after the family declined further treatment. Conclusion: This case offers clinically relevant insights into an atypical presentation of clinically suspected WD. Acute kidney injury (AKI), manifested initially by reduced urine output and elevated serum creatinine, constituted the primary presentation. Moreover, there is a paucity of literature from China describing the use of ECMO in the management of WD-associated severe pneumonia. Accordingly, this case may provide a novel perspective on the management of critically ill patients with severe systemic complications of clinically suspected WD.