PDF(Pubmed)
Abstract：
Adult-onset acquired immunodeficiency caused by anti-IFN-γ autoantibodies is associated with severe opportunistic infection. Due to lack of specific symptoms and different manifestations, this form of infection can be easily misdiagnosed or overlooked. Herein, we present a case of Nocardia farcinica and Talaromyces marneffei co-infection in a patient with anti-IFN-γ autoantibodies (AIGAs). The patient, a 54-year-old man, presented with a 1-month history of fever, coughing and expectoration, dizziness, headache and gait imbalance. Laboratory workup revealed increased inflammatory markers, negative anti-HIV antibody and a high positive titer of AIGAs. Chest computed tomography (CT) showed multiple patches of high-density shadows in both lungs, and brain enhanced magnetic resonance imaging (MRI) showed an irregular lesion. The patient underwent a craniotomy for resection of the lesion. Pulmonary T. marneffei infection was diagnosed through sputum and bronchoalveolar lavage fluid culture, and brain nocardiosis was confirmed via purulent fluid culture of brain tissue. With regular antibiotic therapy, his symptoms improved and there was no recurrence during 18-month follow-up. This may be the first detailed case report detailing infection with these two distinct pathogens in disparate anatomical locations.
摘要：
由抗IFN-γ自身抗体引起的成人发作的获得性免疫缺陷与严重的机会性感染有关。由于缺乏特定的症状和不同的表现，这种形式的感染很容易被误诊或忽视。在这里，我们介绍了一例使用抗IFN-γ自身抗体（AIGA）的患者中诺卡氏菌和马尔尼菲塔拉酵母共感染的病例。病人,一个54岁的男人,有1个月的发烧史,咳嗽和咳痰，头晕,头痛和步态失衡。实验室检查显示炎症标志物增加,抗HIV抗体阴性和高AIGA阳性滴度。胸部计算机断层扫描（CT）显示双肺有多个高密度阴影，脑增强磁共振成像（MRI）显示不规则病变。患者接受了开颅手术切除病变。通过痰和支气管肺泡灌洗液培养诊断为肺马尔尼菲感染，通过脑组织化脓性液体培养证实了脑诺卡病。通过常规抗生素治疗，在18个月的随访中，他的症状有所改善，没有复发。这可能是第一个详细的病例报告，详细说明了在不同的解剖位置中这两种不同病原体的感染。
