Image in medicine
Disseminated Mycobacterium avium and Talaromyces marneffei coinfection
Coinfección diseminada de Mycobacterium avium y Talaromyces marneffei
Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, No. 208 East Huancheng Road, Hangzhou, Zhejiang, China
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He was undergoing antituberculosis treatment for 2 months due to positive sputum smear for acid-fast bacilli (AFB); however, his symptoms were not relieved. Computed tomography revealed left upper lung infection (Panel A) and bone destruction of the thoracolumbar spine (Panel B) and iliac bone. Puncture biopsy of the lumbar vertebrae was performed. <span class="elsevierStyleItalic">Mycobacterium avium</span> infection was confirmed via metagenomic next-generation sequencing (mNGS) detection of puncture specimens. Simultaneously, the sputum AFB smear and nontuberculous mycobacterium (NTM) DNA were positive, and the mycobacterium culture also indicated the presence of <span class="elsevierStyleItalic">M. avium</span>. However, the patient tested negative for HIV. Anti-NTM therapy was initiated, which relieved the symptoms. However, after 1 month, his fever recurred along with the presence of a mass at the top of his head (Panel C). Magnetic resonance imaging revealed epidural abscess with skull damage (Panel D). mNGS of the pus from the mass revealed the presence of <span class="elsevierStyleItalic">Talaromyces marneffei</span>. His temperature returned to normal after receiving antifungal therapy. However, <span class="elsevierStyleItalic">M. avium</span> was still detected in this pus culture; therefore, both anti-NTM and antifungal treatments were simultaneously administered, resulting in favorable outcomes. Opportunistic infection is common in HIV-infected patients. 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