HIV-Negative Case of Talaromyces marneffei Pulmonary Infection with Liver Cirrhosis in China: A Case Report and Literature Review

Abstract

Background: Talaromyces marneffei (TM) is the third most prevalent opportunistic infection in HIV-positive patients after tuberculosis and cryptococcosis. However, such infection of non-HIV individuals has rarely been reported.

Case presentation: We describe a very rare case of a 52-year-old male who presented with a single space-occupying lesion on the right lung and was eventually diagnosed with pulmonary TM infection. The patient was HIV-negative and had liver cirrhosis with portal vein thrombosis. Lung tissue next-generation sequencing (NGS) revealed TM infection. We successfully treated the patient with voriconazole for 8 weeks and observed lesion absorption via subsequent CT. The patient consumed wild bamboo rats two months before admission. Mutations related to congenital immune deficiency were not detected by whole-exome sequencing.

Conclusion: Early and timely diagnosis is critical for improving patient prognosis. NGS plays a vital role in the diagnosis of pulmonary TM infection in patients. To our knowledge, this is the first published case of pulmonary TM infection in an HIV-negative patient with liver cirrhosis.

Keywords: HIV-negative; PVT; Talaromyces marneffei; pulmonary infection.

Figure 1

Chest CT image. (A) A mixed ground glass (4.2*3.7 cm) in the posterior segment of the upper lobe of the right lung on admission (2023-2-28). (B) After effective antifungal therapy, the mixed ground glass opacity (2.5*1.4 cm) in the posterior segment of the upper lobe of the right lung was reduced on March 14, 2023. (C) After effective antifungal therapy, the nodule (11*7 mm) in the posterior segment of the upper lobe of the right lung continued to reduce on April 7, 2023. (D) The nodule (approximately 8 mm) in the posterior segment of the upper lobe of the right lung continued to reduce on April 22, 2023.

Figure 2

Confirmation of TM specific amplification from lung tissue by NGS. (A) The reads mapped to TM derived from NGS data. A total of 51 reads were mapped to TM in the reference database, which contains approximately 2764 pathogen genomes and has a total coverage of 0.0127%. (B) The distribution of microbe sequences (N = 2764 reads) identified in patient plasma, including TM (N = 51; 1.85%), human gammaherpesvirus 4, Pseudomonas sp.R9.37 and others.

Figure 3

Timeline of the patient with relevant data on the episodes and interventions.

Figure 4

Gastroscopy: gastroesophageal varices (severe), portal hypertensive gastropathy.