Abstract: This article reports a rare case of a 55-year-old female patient with AIDS complicated by tropheryma whipplei pneumonia and cutaneous tuberculosis. The patient was admitted to the hospital due to abdominal pain, fever, and cough. She had a history of HIV infection and had been receiving antiretroviral therapy. Laboratory tests showed elevated peripheral blood neutrophil count and CRP levels, and chest CT revealed nodular shadows in both lungs. Initially, she was diagnosed with bacterial pneumonia and treated with cefepime, but the treatment was ineffective. Subsequently, tropheryma whipplei sequences were detected in the bronchoalveolar lavage fluid through nanopore sequencing technology. After switching to trimethoprim-sulfamethoxazole for anti-infection treatment, the patient's body temperature decreased, and her respiratory symptoms improved. Meanwhile, a rash appeared on the patient's right lower limb. Pathological examination suggested granulomatous inflammation due to tuberculosis, and the diagnosis of cutaneous tuberculosis was confirmed in combination with a positive interferon-gamma release assay for tuberculosis. The patient was then treated with standard anti-tuberculosis therapy and her antiviral regimen was adjusted. The patient was discharged after her symptoms improved and continued to receive anti-tuberculosis and anti-AIDS treatment. This article emphasizes that tropheryma whipplei can cause pulmonary infections, and the diagnosis relies on clinical manifestations, histopathological examination, and molecular biological detection. Nanopore sequencing technology can provide rapid and accurate diagnosis. Cutaneous tuberculosis, a rare form of tuberculosis, is mainly diagnosed based on skin histopathological examination and requires long-term combination therapy. This case highlights the diagnostic and therapeutic challenges of infections caused by rare pathogens in HIV-infected individuals and the utility of nanopore sequencing technology in rapid diagnosis. It aims to provide practical diagnostic and therapeutic references for clinicians dealing with such complex infectious cases.

Key words: Acquired immune deficiency syndrome, Tropheryma whipplei pneumonia, Cutaneous tuberculosis, Nanopore sequencing