Division of Pulmonary Medicine, the People's Hospital of Cangnan, Wenzhou Medical University, No.2288, Yucang Road, Cangnan County, Zhejiang, 325800, China.
Division of Pulmonary Medicine, First Affiliated Hospital of Wenzhou Medical University, Key Laboratory of Heart and Lung, Wenzhou, Zhejiang, 325000, China.
BMC Infect Dis. 2018 Aug 10;18(1):390. doi: 10.1186/s12879-018-3290-7.
Talaromyces marneffei (T. marneffei) is a thermal dimorphic pathogenic fungus that often causes fatal opportunistic infections in human immunodeficiency virus (HIV)-infected patients. Although T. marneffei-infected cases have been increasingly reported among non-HIV-infected patients in recent years, no cases of T. marneffei infection have been reported in pulmonary sarcoidosis patients. In this case, we describe a T. marneffei infection in an HIV-negative patient diagnosed with pulmonary sarcoidosis.
A 41-year-old Chinese man who had pre-existing pulmonary sarcoidosis presented with daily hyperpyrexia and cough. Following a fungal culture from bronchoalveolar lavage (BAL), the patient was diagnosed with T. marneffei infection. A high-resolution computed tomography (HRCT) chest scan revealed bilateral lung diffuse miliary nodules, multiple patchy exudative shadows in the bilateral superior lobes and right inferior lobes, air bronchogram in the consolidation of the right superior lobe, multiple hilar and mediastinal lymphadenopathies and local pleural thickening. After 3 mos of antifungal therapy, the patient's pulmonary symptoms rapidly disappeared, and the physical condition improved markedly. A subsequent CT re-examination demonstrated that foci were absorbed remarkably after treatment. The patient is receiving follow-up therapy and assessment for a cure.
This case suggested that clinicians should pay more attention to non-HIV-related lung infections in patients with pulmonary sarcoidosis. Early diagnosis and treatment with antifungal therapy can improve the prognosis of T. marneffei infection.
马尔尼菲青霉（Talaromyces marneffei，T. marneffei）是一种热双相致病真菌，常导致人类免疫缺陷病毒（HIV）感染患者发生致命性机会性感染。尽管近年来越来越多的非 HIV 感染患者报告了马尔尼菲青霉感染病例，但在肺结节病患者中尚未报告过马尔尼菲青霉感染病例。在本病例中，我们描述了一名 HIV 阴性的肺结节病患者发生马尔尼菲青霉感染。
一名 41 岁的中国男性，患有预存的肺结节病，表现为每日高热和咳嗽。支气管肺泡灌洗（BAL）真菌培养后，患者被诊断为马尔尼菲青霉感染。高分辨率计算机断层扫描（HRCT）胸部扫描显示双侧肺弥漫性粟粒结节，双侧上叶和右肺下叶多发斑片状渗出性阴影，实变区空气支气管征，多个肺门和纵隔淋巴结肿大，局部胸膜增厚。经过 3 个月的抗真菌治疗，患者的肺部症状迅速消失，身体状况明显改善。随后的 CT 复查显示，治疗后病灶明显吸收。患者正在接受随访治疗和评估以确定是否治愈。
本病例提示临床医生应更加关注肺结节病患者与 HIV 无关的肺部感染。早期诊断和抗真菌治疗可改善马尔尼菲青霉感染的预后。
