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Absence of cutaneous involvement in disseminated Talaromyces marneffei infection in an AIDS patient: a case report and literature review.
Infect Drug Resist 2019; 12:1493-1499ID

Abstract

Background

Talaromyces marneffei (T. marneffei) is an important opportunistic pathogen found in human immunodeficiency virus-positive individuals in Southeast Asia, Southern China, and Northeastern India. Patients with disseminated talaromycosis commonly develop multi-organ involvement including the skin. In this report, we describe the clinical presentation, investigation, management, and clinical outcome of an acquired immune deficiency syndrome (AIDS) patient with newly diagnosed disseminated talaromycosis without skin involvement.

Case presentation

A 27-year-old male with AIDS presented with acute onset of abdominal pain for 4 days and fever for 2 days. He had been diagnosed with AIDS, pneumocystis pneumonia, and presumptive smear-negative pulmonary tuberculosis 2 months previously. His initial CD4 count was 91 cells/mm3. After a 3-week course of trimethoprim/sulfamethoxazole and anti-tuberculosis treatment, anti-retroviral therapy was initiated. Physical examination revealed left upper quadrant tenderness but no abnormal skin lesions. On this visit, his CD4 count rose to 272 cells/mm3 (19%). Computed tomography of the abdomen showed evidence of a small hypodense lesion with a thin enhancing rim at the spleen and extensive intra-abdominal lymphadenopathy. Empirical amphotericin B deoxycholate was administered in response to positive serum galactomannan, although this was switched to intravenous liposomal amphotericin B 1 week later because of acute kidney injury. Blood and bone marrow cultures for fungus grew T. marneffei on days 9 and 12, respectively. After 21 days of treatment, oral itraconazole replaced intravenous therapy. The patient was discharged home after 29 days in the hospital and continued to improve clinically at a follow-up visit as an outpatient.

Conclusion

Talaromycosis is a fairly common opportunistic infection among AIDS patients in Thailand, despite a rise in CD4 count which may reflect a change in immune status. To a lesser extent, a systemic disease without skin involvement can be expected in real clinical practice.

Authors+Show Affiliations

Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31239726

Citation

Pongpech, Nisha, and Porpon Rotjanapan. "Absence of Cutaneous Involvement in Disseminated Talaromyces Marneffei Infection in an AIDS Patient: a Case Report and Literature Review." Infection and Drug Resistance, vol. 12, 2019, pp. 1493-1499.
Pongpech N, Rotjanapan P. Absence of cutaneous involvement in disseminated Talaromyces marneffei infection in an AIDS patient: a case report and literature review. Infect Drug Resist. 2019;12:1493-1499.
Pongpech, N., & Rotjanapan, P. (2019). Absence of cutaneous involvement in disseminated Talaromyces marneffei infection in an AIDS patient: a case report and literature review. Infection and Drug Resistance, 12, pp. 1493-1499. doi:10.2147/IDR.S207819.
Pongpech N, Rotjanapan P. Absence of Cutaneous Involvement in Disseminated Talaromyces Marneffei Infection in an AIDS Patient: a Case Report and Literature Review. Infect Drug Resist. 2019;12:1493-1499. PubMed PMID: 31239726.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Absence of cutaneous involvement in disseminated Talaromyces marneffei infection in an AIDS patient: a case report and literature review. AU - Pongpech,Nisha, AU - Rotjanapan,Porpon, Y1 - 2019/06/04/ PY - 2019/03/06/received PY - 2019/05/17/accepted PY - 2019/6/27/entrez PY - 2019/6/27/pubmed PY - 2019/6/27/medline KW - AIDS KW - cutaneous involvement KW - disseminated fungal infection KW - talaromycosis SP - 1493 EP - 1499 JF - Infection and drug resistance JO - Infect Drug Resist VL - 12 N2 - Background: Talaromyces marneffei (T. marneffei) is an important opportunistic pathogen found in human immunodeficiency virus-positive individuals in Southeast Asia, Southern China, and Northeastern India. Patients with disseminated talaromycosis commonly develop multi-organ involvement including the skin. In this report, we describe the clinical presentation, investigation, management, and clinical outcome of an acquired immune deficiency syndrome (AIDS) patient with newly diagnosed disseminated talaromycosis without skin involvement. Case presentation: A 27-year-old male with AIDS presented with acute onset of abdominal pain for 4 days and fever for 2 days. He had been diagnosed with AIDS, pneumocystis pneumonia, and presumptive smear-negative pulmonary tuberculosis 2 months previously. His initial CD4 count was 91 cells/mm3. After a 3-week course of trimethoprim/sulfamethoxazole and anti-tuberculosis treatment, anti-retroviral therapy was initiated. Physical examination revealed left upper quadrant tenderness but no abnormal skin lesions. On this visit, his CD4 count rose to 272 cells/mm3 (19%). Computed tomography of the abdomen showed evidence of a small hypodense lesion with a thin enhancing rim at the spleen and extensive intra-abdominal lymphadenopathy. Empirical amphotericin B deoxycholate was administered in response to positive serum galactomannan, although this was switched to intravenous liposomal amphotericin B 1 week later because of acute kidney injury. Blood and bone marrow cultures for fungus grew T. marneffei on days 9 and 12, respectively. After 21 days of treatment, oral itraconazole replaced intravenous therapy. The patient was discharged home after 29 days in the hospital and continued to improve clinically at a follow-up visit as an outpatient. Conclusion: Talaromycosis is a fairly common opportunistic infection among AIDS patients in Thailand, despite a rise in CD4 count which may reflect a change in immune status. To a lesser extent, a systemic disease without skin involvement can be expected in real clinical practice. SN - 1178-6973 UR - https://www.unboundmedicine.com/medline/citation/31239726/Absence_of_cutaneous_involvement_in_disseminated_Talaromyces_marneffei_infection_in_an_AIDS_patient:_a_case_report_and_literature_review L2 - https://dx.doi.org/10.2147/IDR.S207819 DB - PRIME DP - Unbound Medicine ER -
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