PDF(Pubmed)
Abstract：
T. marneffei is opportunistic and dimorphic fungus, which can cause systemic mycosis in human beings. It\'s being difficult to obtain histopathological or microbiological evidence in T. marneffei infection. We reported a rare non-HIV case of T. marneffei infection of bronchopulmonary and mediastinal lymph nodes which was diagnosed by EBUS-TBNA combined with mNGS. The high titer of anti-IFN-γ autoantibodies in serum was probably the cause of T. marneffei infection,which has yet to be fully known.
A 56-year-old Chinese man presented with a 5-month history of intermittent low or high fever and dry cough, followed by fatigue, night sweating, and chest pain when coughing. A large hilar lesion in the left lung and multiple mediastinal lymph node enlargements were found on his chest CT scan.
The patient received EBUS-TBNA of hilar tissue and lymph node biopsy for mNGS at the second Ultrasonic bronchoscopy. No fungal hyphae or spores were found in the histopathology. There were high sequencing reads of T. marneffei in samples of lymph node fluid and bronchogenesis tissue detected by mNGS. His plasma anti-IFN-γ autoantibodies level was positive with a high titer at 1:2500↑.
The patient went through atrial fibrillation at the first dose of amphotericin B liposomes and treated with voriconazole later.
His fever, cough and dyspnea quickly disappeared since the fourth day of treatment. After six months, there was not any focus in his chest CT scans. But his plasma anti-IFN-γ autoantibodies remained unchanged.
Complementing the traditional laboratory and bronchoscopy, mNGS combined with EBUS-TBNA facilitate rapid and precise diagnosis of bronchopulmonary mediastinal lymph nodes T. marneffei infection. Clinicians should be aware of anti-INF-γ autoantibodies in opportunistic infections of non-HIV patients.
A 56-year-old Chinese man presented with a 5-month history of intermittent low or high fever and dry cough, followed by fatigue, night sweating, and chest pain when coughing. A large hilar lesion in the left lung and multiple mediastinal lymph node enlargements were found on his chest CT scan.
The patient received EBUS-TBNA of hilar tissue and lymph node biopsy for mNGS at the second Ultrasonic bronchoscopy. No fungal hyphae or spores were found in the histopathology. There were high sequencing reads of T. marneffei in samples of lymph node fluid and bronchogenesis tissue detected by mNGS. His plasma anti-IFN-γ autoantibodies level was positive with a high titer at 1:2500↑.
The patient went through atrial fibrillation at the first dose of amphotericin B liposomes and treated with voriconazole later.
His fever, cough and dyspnea quickly disappeared since the fourth day of treatment. After six months, there was not any focus in his chest CT scans. But his plasma anti-IFN-γ autoantibodies remained unchanged.
Complementing the traditional laboratory and bronchoscopy, mNGS combined with EBUS-TBNA facilitate rapid and precise diagnosis of bronchopulmonary mediastinal lymph nodes T. marneffei infection. Clinicians should be aware of anti-INF-γ autoantibodies in opportunistic infections of non-HIV patients.
摘要：
背景：T.马内菲是机会性和双态真菌，会导致人体全身性真菌病.很难获得马尼菲感染的组织病理学或微生物学证据。我们报道了一例罕见的非HIV感染支气管肺和纵隔淋巴结的马尔尼菲感染病例，经EBUS-TBNA联合mNGS诊断。血清中高滴度的抗IFN-γ自身抗体可能是马尔尼菲感染的原因。这还没有完全知道。
方法：一名56岁的中国男子，有5个月的间歇性低热或高热和干咳病史，其次是疲劳，晚上出汗，咳嗽时胸痛。在他的胸部CT扫描中发现左肺肺门大病变和纵隔多发淋巴结肿大。
方法：患者在第二次超声支气管镜检查时接受了肺门组织EBUS-TBNA和淋巴结活检的mNGS。在组织病理学中未发现真菌菌丝或孢子。在通过mNGS检测到的淋巴结液和支气管发生组织的样品中存在高测序读数。他的血浆抗IFN-γ自身抗体水平呈阳性，滴度高，为1：2500^。
方法：患者在首次给药两性霉素B脂质体时发生房颤，随后用伏立康唑治疗。
结果：他发烧了，咳嗽和呼吸困难从治疗的第四天开始迅速消失。六个月后,他的胸部CT扫描没有重点.但是他的血浆抗IFN-γ自身抗体保持不变。
结论：补充了传统的实验室和支气管镜检查，mNGS联合EBUS-TBNA有助于快速准确诊断支气管肺纵隔淋巴结马尔尼菲感染。临床医生应注意抗INF-γ自身抗体在非HIV患者的机会性感染中的应用。
方法：一名56岁的中国男子，有5个月的间歇性低热或高热和干咳病史，其次是疲劳，晚上出汗，咳嗽时胸痛。在他的胸部CT扫描中发现左肺肺门大病变和纵隔多发淋巴结肿大。
方法：患者在第二次超声支气管镜检查时接受了肺门组织EBUS-TBNA和淋巴结活检的mNGS。在组织病理学中未发现真菌菌丝或孢子。在通过mNGS检测到的淋巴结液和支气管发生组织的样品中存在高测序读数。他的血浆抗IFN-γ自身抗体水平呈阳性，滴度高，为1：2500^。
方法：患者在首次给药两性霉素B脂质体时发生房颤，随后用伏立康唑治疗。
结果：他发烧了，咳嗽和呼吸困难从治疗的第四天开始迅速消失。六个月后,他的胸部CT扫描没有重点.但是他的血浆抗IFN-γ自身抗体保持不变。
结论：补充了传统的实验室和支气管镜检查，mNGS联合EBUS-TBNA有助于快速准确诊断支气管肺纵隔淋巴结马尔尼菲感染。临床医生应注意抗INF-γ自身抗体在非HIV患者的机会性感染中的应用。
