Department of Pulmonary and Critical Care Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Department of International Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Front Cell Infect Microbiol. 2023 Oct 4;13:1186335. doi: 10.3389/fcimb.2023.1186335. eCollection 2023.
is opportunistic and dimorphic fungus, which can cause systemic mycosis in human beings. It's being difficult to obtain histopathological or microbiological evidence in infection. We reported a rare non-HIV case of infection of bronchopulmonary and mediastinal lymph nodes which was diagnosed by EBUS-TBNA combined with mNGS. The high titer of anti-IFN-γ autoantibodies in serum was probably the cause of infection,which has yet to be fully known.
A 56-year-old Chinese man presented with a 5-month history of intermittent low or high fever and dry cough, followed by fatigue, night sweating, and chest pain when coughing. A large hilar lesion in the left lung and multiple mediastinal lymph node enlargements were found on his chest CT scan.
The patient received EBUS-TBNA of hilar tissue and lymph node biopsy for mNGS at the second Ultrasonic bronchoscopy. No fungal hyphae or spores were found in the histopathology. There were high sequencing reads of in samples of lymph node fluid and bronchogenesis tissue detected by mNGS. His plasma anti-IFN-γ autoantibodies level was positive with a high titer at 1:2500↑.
The patient went through atrial fibrillation at the first dose of amphotericin B liposomes and treated with voriconazole later.
His fever, cough and dyspnea quickly disappeared since the fourth day of treatment. After six months, there was not any focus in his chest CT scans. But his plasma anti-IFN-γ autoantibodies remained unchanged.
Complementing the traditional laboratory and bronchoscopy, mNGS combined with EBUS-TBNA facilitate rapid and precise diagnosis of bronchopulmonary mediastinal lymph nodes infection. Clinicians should be aware of anti-INF-γ autoantibodies in opportunistic infections of non-HIV patients.
是一种机会性和二相性真菌，可导致人类系统性真菌感染。在感染中，很难获得组织病理学或微生物学证据。我们报告了一例罕见的非 HIV 患者支气管肺和纵隔淋巴结感染，该感染通过 EBUS-TBNA 联合 mNGS 诊断。血清中高滴度的抗 IFN-γ 自身抗体可能是感染的原因，但尚未完全了解。
一名 56 岁的中国男性，表现为间歇性低热或高热和干咳 5 个月，随后出现疲劳、夜间出汗和咳嗽时胸痛。胸部 CT 扫描发现左肺门大片病变和多个纵隔淋巴结肿大。
患者在第二次超声支气管镜下接受了 EBUS-TBNA 经支气管针吸活检和 mNGS。组织病理学未发现真菌菌丝或孢子。mNGS 检测到淋巴结液和支气管组织样本中存在高序列读值的。患者血浆抗 IFN-γ 自身抗体水平阳性，滴度高达 1:2500↑。
患者在第一次使用两性霉素 B 脂质体时出现心房颤动，后来改用伏立康唑治疗。
治疗第四天开始，患者的发热、咳嗽和呼吸困难迅速消失。六个月后，胸部 CT 扫描未见任何焦点。但他的血浆抗 IFN-γ 自身抗体仍未改变。
补充传统的实验室和支气管镜检查，mNGS 联合 EBUS-TBNA 有助于快速准确地诊断支气管肺纵隔淋巴结感染。临床医生应该意识到非 HIV 患者机会性感染中的抗 IFN-γ 自身抗体。
