CRA27 RARE INTRUDER: TALAROMYCES MARNEFFEI INFECTION IN AN IMMUNOCOMPETENT HOST

Mathivanan Suppiah 1, Chan Tha Hing 1 Arvindran Alaga1
1. Respiratory department, Hospital Sultanah Bahiyah, Kedah Malaysia

Introduction:

Talaromyces marneffei, previously known as Penicillium marneffei, is an opportunistic fungus endemic in Southeast Asia. It typically harms immunocompromised people, especially HIV/AIDS patients. However, rare cases involving immunocompetent patients have been documented. The clinical manifestation ranges from asymptomatic carrier to severe multi-organ disseminated illness.

Objective 

We present a rare case of Talaromyces marneffei infection in an immunocompetent patient, emphasizing the clinical presentation, diagnostic challenges and management. 

Case report: 

A 51-year-old man with underlying well-controlled diabetes presented with fever, lethargy, neck swelling, cough, skin rash, and breathlessness. Physical examination revealed pleural effusion, multiple cervical lymphadenopathies, and crusted pustular papules rashes at the anterior chest wall. The chest radiograph and CECT TAP revealed a left-sided pleural effusion as well as numerous cervical, mediastinal, axillary, and abdominal lymphadenopathies. He had pleural tapping, bronchoscopy, lymph node, and skin biopsy. All cultures from the biopsy, pleural fluid, bronchoscopy, and blood fungal cultures yielded Talaromyces marneffei. Thus, disseminated Talaromycosis was diagnosed. His histopathological examination resulted as Caseating granulomatosis. His HIV test was negative; serum immunoglobin levels and CD4/CD8 counts were normal. Dermatologists, pulmonologists, and infectious disease specialists co-managed him. Initially, anti-TB medication was prescribed following histopathology findings. However, due to the absence of clinical improvement, intravenous amphotericin and oral itraconazole were administered. Despite the initial improvement after antifungal, this unfortunate gentleman succumbed to disease complications and passed away

Conclusion:

This case emphasizes the risk of Talaromyces marneffei causing disseminated infection even in immunocompetent patients, which is sometimes misdiagnosed as tuberculosis; early detection and effective antifungal therapy are critical for successful outcomes.