Disseminated Mycobacterium kansasii disease complicating Talaromyces marneffei infection in patient with anti-IFN-γ autoantibodies: a case report
Abstract
BACKGROUND: Patients with immunodeficiency syndromes associated with anti-interferon-gamma (IFN-γ) autoantibodies are prone to a wide range of infections, particularly those caused by intracellular pathogens such as nontuberculous mycobacteria (NTM) or Talaromyces marneffei (T. marneffei). However, disseminated Mycobacterium kansasii (M. kansasii) infection co-occurring with T. marneffei infection is relatively rare. Here, we present a case of disseminated M. kansasii disease complicated by T. marneffei infection in a patient with anti-IFN-γ autoantibodies.
CASE PRESENTATION: A 52-year-old man presented with a persistent cough, back pain, fever, generalized rash, and multiple enlarged lymph nodes. Chest computed tomography (CT) revealed hilar Masses, and technetium 99m (Tc-99m) skeletal scintigraphy showed multifocal increased osteoblastic activity. Histopathological examination of the hilar mass biopsy specimens revealed chronic suppurative inflammation. Metagenomic next-generation sequencing (mNGS) of the right submandibular lymph node identified M. kansasii, while blood culture isolated T. marneffei. The patient was diagnosed with disseminated M. kansasii infection co-existing with T. marneffei infection. Additionally, he tested positive for anti-IFN-γ autoantibodies. Combination therapy for NTM-comprising isoniazid, clarithromycin, moxifloxacin, and linezolid-in conjunction with antifungal therapy (amphotericin B followed by itraconazole) achieved a favorable clinical…
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