Background: Mycobacterium fortuitum is a rapidly growing non-tuberculous mycobacterium (NTM) with weak pathogenicity. Here, we present a rare case of disseminated M. fortuitum and Talaromyces marneffei coinfection in a human immunodeficiency virus (HIV) negative patient.
Case Presentation: A 28-year-old female was admitted to our hospital due to 2 months of swelling of lymph nodes on the right side of her cervix, accompanied by repeated low fever for more than 1 month. Biopsy of the right cervical lymph node and endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA) both suggested granulomatous inflammation. The bacterial culture and mycobacteria examination of the lesion as well as HIV antibody test were all negative. Disseminated T. marneffei infection was diagnosed by the quantitative polymerase chain reaction (qPCR) results from the blood showing 1798 copies/ul. In the meantime, treatment with amphotericin B combined with cefoxitin was administered for suspected NTM infection. However, the once-dropped fever recurred and the lymph nodes continued to swell. Metagenomics next-generation sequencing (mNGS) detection of the lymph nodes indicated M. fortuitum. After combination treatment with amphotericin B, voriconazole, linazolamide, and imipenem, the patient’s body temperature returned to normal, the lymph node swelling was gradually reduced, and the lung lesion was absorbed.
Conclusion: We report the first case of an HIV-negative patient diagnosed with disseminated M. fortuitum and T. marneffei coinfection with nonspecific clinical manifestation, in order to heighten awareness of these infections.



中文翻译：

---

非 HIV 病例中偶发分枝杆菌和 Talaromyces marneffei 的播散性合并感染

背景： 偶然分枝杆菌是一种快速生长的非结核分枝杆菌（NTM），致病性较弱。在这里，我们介绍了一个罕见的人类免疫缺陷病毒 (HIV) 阴性患者中传播的偶发分枝杆菌和马尔尼菲 Talaromyces marneffei共感染病例。
案例介绍：患者女，28岁，右侧宫颈淋巴结肿大2个月，伴有反复低热1个多月，入院。右侧颈部淋巴结活检和支气管内超声引导下经支气管细针穿刺 (EBUS-TBNA) 均提示肉芽肿性炎症。病灶细菌培养、分枝杆菌检查及HIV抗体检测均为阴性。传播的 T. marneffei通过血液中的定量聚合酶链反应 (qPCR) 结果显示 1798 拷贝/ul，诊断出感染。同时，对疑似 NTM 感染给予两性霉素 B 联合头孢西丁治疗。然而，一度退烧的高烧再次出现，淋巴结继续肿大。淋巴结的宏基因组学下一代测序 (mNGS) 检测表明偶发分枝杆菌。经两性霉素B、伏立康唑、利那唑胺、亚胺培南联合治疗后，患者体温恢复正常，淋巴结肿大逐渐减轻，肺部病灶吸收。
结论：我们报告了第一例被诊断为播散性偶发分枝杆菌的 HIV 阴性患者和T. marneffei合并感染与非特异性临床表现，以提高对这些感染的认识。