Unusual disseminated Talaromyces marneffei infection presenting with fever and diarrhea in an AIDS patient: a case report and literature review.

Abstract

Background: Gastrointestinal symptoms are not uncommon in patients infected with Talaromyces marneffei (T. marneffei). However, the reports on intestinal T. marneffei infection were rare. We report a case of disseminated T. marneffei infection with intestine involvement.

Case presentation: A 41-year-old female with acquired immune deficiency syndrome (AIDS) was admitted to our hospital for long-term fever, followed by abdominal pain and diarrhea. The colonoscopy performed in our hospital revealed ulcerative lesions in the colon and terminal ileum. Periodic acid-Schiff (PAS) staining of intestinal ulcer revealed that the small dots distributed inside and outside of the macrophages were yeast microorganisms. Further culture of bone marrow sample was confirmed T. marneffei positive. A diagnosis of disseminated T. marneffei infection was made, with intestine involvement. We also summarized the clinical characteristics, endoscopic findings and histopathological features of intestinal T. marneffei by literature review.

Conclusion: In HIV-infected and other immunocompromised patients with gastrointestinal symptoms and/or associated abdominal imaging abnormalities, intestinal T. marneffei infection should be taken into consideration. Serious manifestations such as intestinal obstruction and intestinal perforation may occur. Early diagnosis is of great significance to prevent the deterioration of the illness and improve the prognosis. Histopathological examination and culture of intestinal lesions are helpful to improve the diagnosis of intestinal T. marneffei infection.

Abbreviations: AIDS: acquired immune deficiency syndrome; ART: antiretroviral therapy; ESR: erythrocyte sedimentation rate; PPD:purified protein derivative; HE: Hematoxylin and eosin; PAS: Periodic acid-Schiff; CMV: cytomegalovirus; GMS:Gomori's methenamine silver nitrate.