Disseminated Talaromyces marneffei infection presenting as pulmonary cavitary nodules: a case report

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BACKGROUND: Talaromycosis is an invasive fungal infection with high mortality in patients with advanced human immunodeficiency virus (HIV) disease in the tropical and subtropical regions of Asia. The lungs are the most commonly involved organ, and chest computed tomographic (CT) typically reveals diffuse pulmonary reticular and ground-glass changes. However, cavitary nodules are rare in HIV-positive patients, often leading to delay diagnosis. CASE PRESENTATION: A 46-year-old female with a 3-year history of untreated HIV infection was referred to our hospital due to recurrent fever lasting for 4 months. The chest CT showed a large nodular lesion with cavitary in the right lung, which was initially considered a neoplastic lesion at the referring hospital. A CT-guided percutaneous lung biopsy was performed, and fungal spores were found in lung pathology. Talaromyces marneffei was cultured from lung tissue and bone marrow at 4-day and 10-day post-sampling, respectively. The patient was diagnosed with disseminated talaromycosis. The patient received a two-week induction therapy with amphotericin B, resulting in a remarkable clinical response with substantial resolution of the cavitary pulmonary nodules. Following discharge, the patient continued antifungal therapy with itraconazole, and showed no evidence of disease recurrence during the 1-year follow-up period. CONCLUSIONS: This case highlights that pulmonary talaromycosis may present as cavitary nodular lesions, and further microbiological examination is indispensable for definitive diagnosis.

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