1例非HIV感染者马尔尼菲篮状菌肺炎伴溶骨性破坏

Talaromyce marneffei pneumonia with osteolytic destruction in a non-HIV patient

目的探讨1例以骨痛、肌肉疼痛为首发症状的HIV阴性患者播散性感染马尔尼菲篮状菌(Talaromyce marneffei,T.marneffei)肺炎伴溶骨性破坏病例的临床特征和诊疗过程,为马尔尼菲篮状菌病流行地区免疫功能正常人群的这种罕见病诊疗提供参考资料。方法现收集该病例的影像学检查结果、实验室检测结果、临床诊治过程及流行病学特点等资料进行分析。结果该患者广西人,67岁,2型糖尿病患者,无免疫受损基础疾病,临床表现以肺部症状及骨痛、肌肉疼痛为主,全程无发热,HIV阴性,血培养、骨髓培养均无菌生长,气管吸物培养出T.marneffei,骨ETC提示考虑特殊菌感染的可能,给予两性霉素B和伊曲康唑治疗近1个月后好转,予带药出院。近2个月后患者来医院复诊,其生命体征正常,骨痛消失,电解质、肌酐、血常规未见异常,肺部CT显示两肺炎症较前稍减少。结论非HIV感染者播散性感染T.marneffei肺炎伴溶骨性破坏在国内报道少见,总结其临床特征及诊疗过程,旨在提高临床医生对T.marneffei流行地区HIV阴性患者这种罕见病的认识,尽早进行抗真菌治疗,降低死亡率。

Objective To discuss the clinical characteristics,diagnosis and treatment process of an HIV negative patient with bone ache and muscle pain as the first symptom,who was infected with Talaromyce marneffei(T.marneffei)pneumonia with osteolytic destruction,so as to provide reference for the diagnosis and treatment of this rare disease in the population with normal immune function in the epidemic area of Talaremycosis marneffei.Methods The data of laboratory test results,clinical diagnosis and treatment experience and epidemiology,were collected and analyzed.Results A 67-years-old patient who came from Guangxi,China,with no underlying immunodeficiency.The clinical manifestations were mainly pulmonary symptoms,bone ache and muscle pain,no fever throughout the course of the disease.He was a type 2 diabetic and HIVnegative,and did not merge the underlying disease with immune impairment.Blood and bone marrow cultures showed no bacterial growth,but T.marneffei was isolated from the tracheal suction sample.ECT image of bones suggested the possibility of special bacterial infection,his clinical status was improved and discharged after nearly a month of amphotericin B and itraconazole treatment.Two months later,the patient returned for a follow-up visit,with normal vital signs,no bone pain,no abnormalities in electrolytes,creatinine,or blood routine,and chest CT showing a slight decrease in bilateral pneumonia compared to before.Conclusions Disseminated infection of T.marneffei pneumonia with osteolytic destruction in non-HIV patients is rare in domestic reports.The summary of clinical features and the diagnosis and treatment process in this report aim to raise awareness among clinicians of this rare disease in HIV-negative patients in T.marneffei-endemic areas,to initiate antifungal treatment as early as possible,and to reduce mortality.