Cerebral vasculitis caused by Talaromyces marneffei and Aspergillus niger in a HIV-positive patient: a case report and literature review

Abstract

Cerebral vasculitis is a long-standing but flourishing and fadeless research topic. Infections are a frequent cause of cerebral vasculitis, vital to diagnose due to involvement of specific anti-infection treatments. A 65-year-old man visited the hospital for his neurological symptoms without obvious inducements. After admission, radiological examination and comprehensive conventional microbiological tests (CMTs) revealed suspected intracranial infectious vasculitis. Metagenomic next-generation sequencing (mNGS) and reverse transcription-polymerase chain reaction further confirmed that his cerebral vasculitis was caused by Talaromyces marneffei (T. marneffei) and Aspergillus niger (A. niger) co-infection. The patient’s final diagnosis changed from initial herpetic encephalitis, due to the past history of cephalosome and facial herpes and non-significant antiviral therapeutic effects, to fungal cerebral vasculitis. The patient was discharged after use of targeted antifungal therapies on day 18 of his admission, and his associated symptoms disappeared completely at follow-up 3 weeks later. We first illustrated the presence of uncommon cerebral vasculitis caused by T. marneffei and A. niger in a human immunodeficiency virus-positive patient. In clinically suspected patients with infectious cerebral vasculitis, mNGS should be performed to detect potential pathogens if CMTs may not provide useful pathogenic clues, highlighting the importance of mNGS in the diagnosis and treatment of infectious diseases.

Coexisting of Primary Central Nervous System Lymphoma and Talaromyces marneffei Brain Abscess in an AIDS Patient, A Case Report and Review of the Literature

“…The diffuse involvement of Talaromyces marneffei in the central nervous system (CNS) is a rare occurrence, and in HIV patients infected with Talaromyces marneffei in the CNS, the mortality is 81%. 26 , 27 A study in Guangxi province, South China, involving HIV/AIDS patients, found that 10 out of 159 patients had meningitis due to Talaromyces marneffei infection, and 9 out of 10 patients had intracranial lesions. 28 Another study reported that 4/10 patients had intracranial infection after discovering Talaromyces marneffei in the cerebrospinal fluid.…”

Cerebral Infectious Opportunistic Lesions in a Patient with Acute Myeloid Leukaemia: The Challenge of Diagnosis and Clinical Management

“…Infections are a frequent cause of cerebral vasculitis, which can be caused by angiotropic pathogens (varicella zoster virus, Treponema pallidum, Aspergillus) [19]. Some reports highlighted the association between CNS IA and secondary vasculitis of large vessels, usually documented by histology, and the need for steroid therapy alongside AFT [20][21][22]. Although the histology of the brain biopsy in our case did not support the presence of vasculitis and the cerebral CT angiography was unremarkable (despite its low sensitivity for vasculitis), considering the increasing peri-lesion oedema of CNS lesions at brain MRI without the appearance of new localisations during the follow-up, a course of steroids (similarly to the gluco-corticoid regimen adopted for remission induction in non-severe forms of giant cell arteritis [23]) was administered.…”

Microbiomes Detected by Bronchoalveolar Lavage Fluid Metagenomic Next-Generation Sequencing among HIV-Infected and Uninfected Patients with Pulmonary Infection

“…In HIV-infected patients, the number of case reports that identify pathogens of different infectious diseases by mNGS has increased in recent years ( 9 – 13 ). However, so far, there has been no study investigating and summarizing the lung microbiome spectra among HIV-infected patients with pulmonary infection by mNGS.…”