Gastrointestinal Talaromyces marneffei infection in a man with AIDS: A case report.

RATIONALE: Reports of intestinal Talaromyces marneffei infection have increased year by year, but those of gastric infection remain rare. Here, we report disseminated talaromycosis with gastric and intestinal ulcers in an AIDS patient who was treated by antifungal agents and a proton pump inhibitor and achieved a satisfactory outcome. PATIENT CONCERNS: A 49-year-old man developed a gastrointestinal illness with main abdominal distension, poor appetite and a positive HIV infection to our AIDS clinical treatment center. DIAGNOSES: Electronic gastrointestinal endoscopy showed that the patient had multiple ulcers in the gastric angle, gastric antrum and large intestine. Gastric Helicobacter pylori infection was ruled out by paraulcerative histopathological analysis and a C14 urea breath test. The diagnosis was confirmed by gastroenteroscopic biopsy and metagenomic next-generation sequencing of gastric ulcer tissue. INTERVENTIONS: Symptomatic and supportive treatments [a proton pump inhibitor and gastrointestinal motility promotion] were initiated. The patient was prescribed sequential antifungal therapy with amphotericin B (0.5 mg/kg·d, 2 weeks) and itraconazole (200 mg, q12h, 10 weeks), and then followed with itraconazole for long-term secondary prevention (200 mg, qd). OUTCOMES: The combined use of antifungal agents and a proton pump inhibitor improved the patient's condition, and he was discharged home 20 days later. He had no gastrointestinal symptom during 1 year of telephone-based follow-up. LESSONS: In endemic areas, clinicians should be alert to the possibility of Talaromyces marneffei infection presenting with gastric ulcers in patients with AIDS, after excluding Helicobacter pylori infection.

Clinical Characteristics of HIV-Associated Talaromyces marneffei Infection of Intestine in Southern China.

Intestinal Talaromyces marneffei (TM) infection among patients with HIV/AIDS is rare. Herein, we report 31 cases of intestinal TM infection in Guangxi. Most patients exhibited fever, lymphadenectasis in the abdominal cavity, and chronic intestinal symptoms. CD4+ T-cell counts <50 cells/µL were reported in 28 patients. TM was cultured from the blood of 23 patients and from the marrow of 7 patients, whereas TM-like fungal spores in the cytoplasm of tissues with erosion, ulceration, and/or polyps were found in all 31 patients. We suggest that intestinal TM infection should be considered among patients infected with HIV with extremely low CD4+ T-cell counts (<50 cells/µL) who are manifesting fever, chronic gastrointestinal symptoms, and endoscopic evidence of erosion and/or ulceration.