Журнал клинических случаев

Talaromyces Marneffei Infection Inducing Hemophagocytic Syndrome in an HIV-negative Adult Patient

Abstract

Liyi Hu, Ling Liu, Lunyu Yang, Yuling Yi, Taimei Duan, Dongmei Huang, Sitian Tang, Zhu Mei, Xinlu Bai, Xianping Luo and Yong Luo

Background: Talaromyces Marneffei (TM) infection is commonly seen in HIV-positive or immunocompromised patients but rarely reported in HIV-negative individuals. Hemophagocytic syndrome is one of a group of syndromes characterized by overactivity of immune cells resulting in the production of excessive inflammatory factors and causing damage to multiple organs.

Case presentation: This case report presents a previously healthy 52-year-old male patient who experienced persistent fever and chills for over 20 days. Initial blood tests revealed decreased hemoglobin and platelets, and increased proportion of neutrophils. Laboratory examinations showed elevated levels of procalcitonin, C-reactive protein, erythrocyte sedimentation rate, ferritin, along with abnormalities in liver function. Imaging studies indicated hepatosplenomegaly. Tests for common infectious diseases, autoimmune liver diseases, and blood cultures all yielded negative. A bone marrow aspiration smear revealed a suspected TM fungus, which was later confirmed through culture and sequencing. However, the patient's condition rapidly deteriorated, with the presence of histiocytes and hemophagocytes, along with severe liver damage and coagulation disorders, progressing to hemophagocytic syndrome with a poor prognosis.

Conclusion: The nonspecific symptoms of TM infection in HIV-negative patients can lead to misdiagnosis and delayed treatment. Therefore, it is crucial for clinicians to promptly recognize TM infection in HIV-negative individuals and initiate early antifungal treatment to prevent the progression of diseases with poor prognosis.