PDF(Pubmed)
Abstract：
We reported a 31-year-old man who received renal transplantation for more than 2 years. He was admitted to our hospital on 9 March 2022 due to intermittent diarrhea accompanied by leukopenia for more than 1 month. The patient successively developed high fever, cough, anemia, weight loss, gastrointestinal bleeding, and liver function impairment. Computed tomography (CT) revealed a slight inflammation in the lower lobes of both lungs, enlargement of the lymph nodes in the retroperitoneal and the root of mesenteric areas, and hepatosplenomegaly. Talaromyces marneffei was detected by metagenomics next-generation sequencing (mNGS) in blood and bronchoalveolar lavage fluid, and the pathogen was subsequently verified by blood culture. After endoscopic hemostatic therapy and antifungal therapy with voriconazole and amphotericin B cholesteryl sulfate complex, the patient was successfully discharged. Oral voriconazole was given regularly after discharge. Diarrhea, fever, enlargement of the lymph nodes, and endoscopic evidence of erosion may indicate intestinal T. marneffei infection. Although the mortality of T. marneffei infection after renal transplantation is very high, timely and effective antifungal therapy with amphotericin B cholesteryl sulfate complex is still expected to improve its prognosis.
摘要：
我们报道了一名31岁的男子，他接受了2年以上的肾移植。他于2022年3月9日因间歇性腹泻伴白细胞减少症住院超过1个月。患者先后出现高烧,咳嗽,贫血,减肥,消化道出血,和肝功能损害。计算机断层扫描（CT）显示双肺下叶有轻微的炎症，腹膜后和肠系膜根部淋巴结肿大，和肝脾肿大.通过宏基因组学下一代测序（mNGS）在血液和支气管肺泡灌洗液中检测到马尔尼菲塔拉酵母，随后通过血液培养证实了病原体。经伏立康唑和两性霉素B胆固醇硫酸盐复合物的内镜止血治疗和抗真菌治疗后，病人成功出院。出院后定期口服伏立康唑。腹泻,发烧,淋巴结肿大，和胃镜下侵蚀的证据可能表明肠道马尔尼菲感染。尽管肾移植术后马尔尼菲感染的死亡率很高，两性霉素B胆固醇硫酸酯复合物的及时有效抗真菌治疗仍有望改善其预后。
