Unusual disseminated Talaromyces marneffei infection mimicking lymphoma in a non-immunosuppressed patient in East China: a case report and review of the literature

BMC Infectious Diseases

Ming Chen¹  Chengdong Chang²  Donghe Chen³  Xin Zhao³  Tingting Zhang³  Yafei Zhang³  Zhen Wang³  Kui Zhao³  Huanyan Zhu³  Jing Yan³  Lin Zheng⁴ 

[1] BGI Genomics, 518083, Shenzhen, Guangdong, P.R. China;Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Zhejiang, Hangzhou, P.R. China;PET Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 310003, Zhejiang, Hangzhou, P.R. China;State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, 310003, Zhejiang, Hangzhou, P.R. China;

关键词: Talaromyces marneffei;    Non-AIDS patient;    Non-immunosuppressed patient;    FDG PET/CT;    Delay in diagnosis;   

DOI  :  10.1186/s12879-020-05526-1

来源: Springer

【 摘 要 】

BackgroundTalaromyces marneffei infection is an important opportunistic infection associated with acquired immune deficiency syndrome (AIDS). However, it is unusual in patients with non-AIDS and other non-immunosuppressed conditions. We report a case of delayed diagnosis of disseminated T. marneffei infection in non-AIDS, non-immunosuppressive and non-endemic conditions.Case presentationWe describe a previously healthy 24-year-old man who complained of a 3-month history of intermittent diarrhea and a recent week of uncontrollable high fever. The HIV antibody test was negative. Enhanced abdominal computed tomography (CT) and integrated 18F-2-deoxy-2-fluoro-D-glucose position emission tomography/computed tomography (FDG PET/CT) both suspected malignant lymphoma. However, a large number of yeast-like cells were found in macrophages in cervical lymph node samples by hematoxylin and eosin stain and silver hexamine stain. Subsequent blood culture suggested T. marneffei infection. Metagenomic Next Generation Sequencing (mNGS) results suggested T. marneffei as the dominant pathogen. Unfortunately, the patient continued to develop acute liver failure and died due to adverse events associated with amphotericin B.ConclusionsEarly diagnosis in HIV-negative patients who are otherwise not immunosuppressed and endemic poses a serious challenge. T. marneffei infection is an FDG-avid nonmalignant condition that may lead to false-positive FDG PET/CT scans. Nevertheless, integrated FDG PET/CT is necessary in patients with fever of unknown origin in the early period to perform earlier biopsy for histopathology and culture in highly avid sites and to avoid delays in diagnosis and treatment.

【 授权许可】

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