Qiujing Li,1 Mingwu Li,2 Shuxian Wang,2 Alan F Geater,3 Jingyi Dai1 

1Department of Public Laboratory, The Third People’s Hospital of Kunming City, Infectious Disease Clinical Medical Center of Yunnan Province, Kunming, Yunnan, People’s Republic of China; 2Department of Tuberculosis, The Third People’s Hospital of Kunming City, Infectious Disease Clinical Medical Center of Yunnan Province, Kunming, Yunnan, People’s Republic of China; 3Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand

Correspondence: Jingyi Dai, Department of Public Laboratory, The Third People’s Hospital of Kunming City, Kunming, People’s Republic of China, Email daijingyidjy@163.com

Abstract: This case reports a middle-aged male patient who was HIV-negative and initially misdiagnosed as pulmonary tuberculosis but was eventually diagnosed with disseminated Talaromyces marneffei (T. marneffei) infection by next-generation sequencing. The patient presented with respiratory symptoms, recurrent bone pain, and subcutaneous masses as the main symptoms. After one year of antifungal treatment, the symptoms improved obviously, but the symptoms recurred after two weeks of drug withdrawal, and the symptoms were relieved after re-administration of antifungal drugs again. This report highlights the need for the rapid evaluation of fungal infections with metagenomic next-generation sequencing (mNGS) in patients with an inadequate diagnostic basis for tuberculosis infection or a poor response to antituberculosis drugs. In addition, long-term follow-up is needed to observe disease recurrence in patients with disseminated T. marneffei infection.

Keywords: Talaromyces marneffei, HIV-negative patient, tuberculosis, misdiagnose, Next-generation sequencing