Gastrointestinal Talaromyces marneffei infection in a patient with AIDS: A case report and systematic review

Abstract

Talaromyces marneffei is a thermally dimorphic fungus that affects multiple organs and frequently invades immunocompromised individuals. However, only a few studies have reported the presence of intestinal infection associated with T. marneffei. Herein, we reported a case of intestinal T. marneffei infection in a man who complained of a 1-month history of intermittent fever, abdominal pain, and diarrhea. The result of the human immunodeficiency virus antibody test was positive. Periodic acid-Schiff and Gomorrah’s methylamine silver staining of the intestinal biopsy tissue revealed T. marneffei infection. Fortunately, the patient’s symptoms rapidly resolved with prompt antifungal treatment. In addition, we summarized and described the clinical characteristics, management, and outcomes of patients with intestinal T. marneffei infection. A total of 29 patients were identified, the majority of whom (65.52%) were comorbid with acquired immunodeficiency syndrome. The main clinical features included anemia, fever, abdominal pain, diarrhea, weight loss, and lymphadenopathy. The transverse and descending colon, ileocecum, and ascending colon were the most common sites of lesions. A considerable number of patients (31.03%) developed intestinal obstruction, intestinal perforation, and gastrointestinal bleeding. Of the 29 patients, six underwent surgery, 23 survived successfully with antifungal treatment, five died of T. marneffei infection, and one died of unknown causes. T. marneffei intestinal infection should be considered when immunodeficient patients in endemic areas present with non-specific symptoms, such as fever, abdominal pain, and diarrhea. Appropriate and timely endoscopy avoids delays in diagnosis. Early aggressive antifungal therapy improves the clinical outcomes of patients.

A case of TM infection with challenging differential diagnosis from lymphoma post-renal transplant

“…Disseminated TSM has a high fatality rate, and the mortality rate can reach 24–33% after antimicrobial treatment [ 8 ]. However, due to the hidden onset, patients and doctors might not pay much attention to it in the early stage, so it is easy to misdiagnose and delay treatment [ 9 ]. TM can spread to multiple systems through the blood, such as the respiratory system, digestive system, reticuloendothelial system, and easily invade the mononuclear macrophage system [ 8 ].…”

“…Considering the clinical manifestation features (stomachache, intestinal bleeding, and extensive lymphadenopathy), the differential diagnosis of gastrointestinal tumors, tuberculosis, lymphoma, and Crohn’s disease should be considered. Symptoms of TSM in 18.8 to 31% present with gastrointestinal bleeding, primarily affecting the colon [ 9 ]. The best differential diagnosis is colon endoscopy and biopsy [ 9 ].…”

“…Symptoms of TSM in 18.8 to 31% present with gastrointestinal bleeding, primarily affecting the colon [ 9 ]. The best differential diagnosis is colon endoscopy and biopsy [ 9 ]. Intestinal bleeding may first be caused by TM affecting the intestinal tract (multiple ulcers).…”