Infection and drug resistance · 2025
Invasive Talaromyces marneffei Fungemia in an HIV-Negative Patient with T-Prolymphocytic Leukaemia: A Case Report and Review of Emerging Risks.
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Zhan Lili, Wang Qun, Zhang Xiaoyu, Tan Yangyang, Zhang Li
Аннотация
BACKGROUND: Talaromyces marneffei (T. marneffei) is a thermally dimorphic fungus traditionally associated with HIV-related immunosuppression. However, increasing reports have described infections in HIV-negative patients with hematologic malignancies, particularly those receiving novel immunosuppressive therapies.
CASE PRESENTATION: We report a case of disseminated T. marneffei in an HIV-negative 55-year-old woman with T-prolymphocytic leukaemia (T-PLL) undergoing chemotherapy and targeted therapy with chidamide and golidocitinib. The patient presented with fever, pancytopenia, and signs of systemic infection. Blood cultures confirmed T. marneffei, with identification supported by dual-phase morphology and internal transcribed spacer (ITS) sequencing. Due to unavailability of amphotericin B, the patient was treated successfully with voriconazole, achieving rapid clinical improvement and negative follow-up cultures.
DISCUSSION: This case adds to the growing evidence that T. marneffei can cause invasive infections in non-HIV immunocompromised hosts. Through a review of 10 published cases, we identify common features such as neutropenia, kinase inhibitor use, and diagnostic delays. We emphasize the importance of early fungal culture and phase-specific morphology for diagnosis, and highlight voriconazole as a viable alternative therapy when amphotericin B is inaccessible.
CONCLUSION: Clinicians should maintain high suspicion for talaromycosis in immunosuppressed hematologic patients in endemic regions, regardless of HIV status. Prompt recognition and appropriate antifungal therapy are essential to improve outcomes.
CASE PRESENTATION: We report a case of disseminated T. marneffei in an HIV-negative 55-year-old woman with T-prolymphocytic leukaemia (T-PLL) undergoing chemotherapy and targeted therapy with chidamide and golidocitinib. The patient presented with fever, pancytopenia, and signs of systemic infection. Blood cultures confirmed T. marneffei, with identification supported by dual-phase morphology and internal transcribed spacer (ITS) sequencing. Due to unavailability of amphotericin B, the patient was treated successfully with voriconazole, achieving rapid clinical improvement and negative follow-up cultures.
DISCUSSION: This case adds to the growing evidence that T. marneffei can cause invasive infections in non-HIV immunocompromised hosts. Through a review of 10 published cases, we identify common features such as neutropenia, kinase inhibitor use, and diagnostic delays. We emphasize the importance of early fungal culture and phase-specific morphology for diagnosis, and highlight voriconazole as a viable alternative therapy when amphotericin B is inaccessible.
CONCLUSION: Clinicians should maintain high suspicion for talaromycosis in immunosuppressed hematologic patients in endemic regions, regardless of HIV status. Prompt recognition and appropriate antifungal therapy are essential to improve outcomes.