Background Talaromyces marneffei infection is an important opportunistic infection associated with acquired immune deficiency syndrome (AIDS). However, it is unusual in patients with non-AIDS and other non-immunosuppressed conditions. We report a case of delayed diagnosis of disseminated T. marneffei infection in non-AIDS, non-immunosuppressive and non-endemic conditions. Case presentation We describe a previously healthy 24-year-old man who complained of a 3-month history of intermittent diarrhea and a recent week of uncontrollable high fever. The HIV antibody test was negative. Enhanced abdominal computed tomography (CT) and integrated 18F-2-deoxy-2-fluoro-D-glucose position emission tomography/computed tomography (FDG PET/CT) both suspected malignant lymphoma. However, a large number of yeast-like cells were found in macrophages in cervical lymph node samples by hematoxylin and eosin stain and silver hexamine stain. Subsequent blood culture suggested T. marneffei infection. Metagenomic Next Generation Sequencing (mNGS) results suggested T. marneffei as the dominant pathogen. Unfortunately, the patient continued to develop acute liver failure and died due to adverse events associated with amphotericin B. Conclusions Early diagnosis in HIV-negative patients who are otherwise not immunosuppressed and endemic poses a serious challenge. T. marneffei infection is an FDG-avid nonmalignant condition that may lead to false-positive FDG PET/CT scans. Nevertheless, integrated FDG PET/CT is necessary in patients with fever of unknown origin in the early period to perform earlier biopsy for histopathology and culture in highly avid sites and to avoid delays in diagnosis and treatment.
Mucormycosis is a rare opportunistic infection usually associated with immunosuppression, diabetes mellitus or haematological malignancy. Herein, we report an unusual case of mucormycosis in a 46-yr-old male patient with diabetes presenting with an endotracheal mass obstructing the trachea and cartilage damage. Histological examination of the bronchoscopy biopsy specimens revealed invasive mucormycosis. The patient was treated with intravenous amphotericin B followed by removal of the lesion via bronchoscopy.KEYWORDS: Cartilage damage, dyspnoea, mucormycosis, tracheal stenosis M ucormycosis, also called zygomycosis, is an important opportunistic infection caused by fungus that belongs to the class Zygomycetes, which is the third most common invasive fungal infection after candidosis and aspergillosis [1]. Although the infection rate of mucormycosis is very low, patients with immunosuppression, diabetes mellitus or haematological malignancy are at the highest risk for mucormycosis. Mucorales rarely invades the trachea. Tracheal cartilage damage is extremely rare in pulmonary mucormycosis. Herein, we report an unusual case of mucormycosis in a diabetic male presenting with an endotracheal mass obstructing the trachea and cartilage damage with histological confirmation of endotracheal mucormycosis. CASE REPORTA 46-yr-old male nonsmoker was admitted to our hospital (West China Hospital, Sichuan University, Chengdu, China) because of throat discomfort, cough and expectoration of 1 month duration. Simultaneously, he had mild dyspnoea, especially during exercise. He also had type 2 diabetes, which had been diagnosed ,5 yrs previously; his diabetes had been poorly controlled by diet alone. Physical examination revealed that bilateral lung breathing sounded rough and moist rales could be heard in the left lung. Laboratory data showed that the white blood cell count was 11.82610 9 L -1 with 76.7% neutrophils and hyperglycemia (18.57 mmol?L -1 ) was observed. Blood urea nitrogen and creatinine were normal. Acid-fast bacilli smears and cultures of sputum were negative. We also excluded the possibility of HIV infection. Computed tomography of the chest and neck indicated that the tracheal wall was thickened, the cricoid cartilage was damaged and the lumen was narrow ( fig. 1). Fibreoptic bronchoscopy revealed that the upper airway mucosal was oedematus, thickened and that the lumen was narrow and funnel-shaped. A valve-like neoplasma was seen on the right wall of upper trachea ( fig. 2). Biopsies were obtained by removal of the lesion via bronchoscopy and the histological sections revealed moderate chronic inflammation in the mucosa of the upper trachea, associated with inflammatory exudates, necrosis, granulation tissue proliferation and numerous hyphae of mucormycosis. Histochemical staining indicated negative acid-fast stain, positive periodic acidSchiff, positive hexamine stain and positive mucus carmine stain. He was diagnosed with endotracheal mucormycosis with granulation formation and diabetes mellitus.Diab...
Background: To investigate the prognostic value of clinical features and metabolic parameters in pretreatment 18 F-2-fluoro-2-deoxy-D-glucose ( 18 F-FDG) positron emission tomography/X-ray computed tomography (PET/CT) scans of patients with angiosarcoma, a rare neoplasm that has not been well characterized.Methods: In this retrospective study, 19 patients with a histopathologically confirmed diagnosis of angiosarcoma who had undergone pretreatment 18 F-FDG PET/CT scans were enrolled. We recorded the age at presentation, sex, underlying diseases, sites of primary tumors, Karnofsky Performance Status (KPS) score, Eastern Cooperative Oncology Group (ECOG) score, time from onset to diagnosis, laboratory examinations, sites and sizes of primary tumors, treatment modalities, histologic features and American Joint Committee on Cancer (AJCC) stage, maximum standardized uptake value (SUVmax), average SUV (SUVavg), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of primary tumors and the whole body.Univariate and multivariate survival analyses for overall survival were performed according to the metabolic parameters and other clinical variables.Results: Patients ranged in age from 27 to 79 years (median: 59 years) with different angiosarcoma types covering all tumor grades and subtypes. Seven (7/19) patients had anemia of varying degrees of severity.Lymph node metastases (n=10) and/or distant metastases (n=11) of angiosarcoma were common. Bone or bone marrow (10/19) and lung (8/19) were the most common distant metastatic organs. Patients with bone metastases, low hemoglobin levels and high ferritin levels had significantly poorer overall survival than those with non-bone metastases, normal hemoglobin levels and normal ferritin levels by the log-rank test, with P values of 0.027, 0.030 and 0.015, respectively. Patients with multiple organ metastases had significantly poorer overall survival than those with single organ metastasis (log-rank P=0.008). In multivariate survival analysis, only whole-body metabolic tumor volume using SUV max cut-off value of 2.5 (wMTV 2.5 ) was a significant independent prognostic factor. For wMTV 2.5 , 870.3 cm 3 was the best cut-off point to discriminate between a good and poor prognosis (log-rank P=0.01). Conclusions:The systemic 18 F-FDG PET/CT with high sensitivity and specificity has significant ^ ORCID: 0000-0003-3388-7907. advantages in the evaluation of angiosarcoma, particularly in detecting occult metastases. Bone metastases on 18 F-FDG PET/CT, low hemoglobin levels and high ferritin levels were all associated with a poorer prognosis. MTV 2.5 of the whole body is a significant independent metabolic prognostic factor for overall survival in patients with angiosarcoma.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.