PT  - JOURNAL ARTICLE
AU  - Kuan Pin Lim
AU  - Melanie Lavender
AU  - Peter Boan
AU  - Cecily Metcalf
AU  - Kay-Vin Lam
AU  - Jeremy Wrobel
AU  - Michael Musk
TI  - First reported case of disseminated <em>talaromyces marneffei</em> infection in a lung transplant patient
DP  - 2014 Sep 01
TA  - European Respiratory Journal
PG  - P2465
VI  - 44
IP  - Suppl 58
4099  - http://erj.ersjournals.com/content/44/Suppl_58/P2465.short
4100  - http://erj.ersjournals.com/content/44/Suppl_58/P2465.full
SO  - Eur Respir J2014 Sep 01; 44
AB  - Background: We describe a case of disseminated Talaromyces marneffei infection presenting with severe airway involvement in a lung transplant recipient. T. marneffei is a dimorphic fungus endemic to South East Asia and South China.Findings: A 41 year old Caucasian Australian lady with good graft function (BOS grade 0) 2 years 5 months post-bilateral sequential lung transplantation for cystic fibrosis presented with a mild cough and drop in FEV1 on routine follow-up. She had travelled to Vietnam 10 months ago.CT thorax demonstrated bulky mediastinal and large left hilar adenopathy with compression of the lingular airway, a small left upper lobe cavitating nodule and enlarged subclavicular lymph nodes. All the lymph nodes and the nodule were highly FDG-avid on PET. Bronchoscopy revealed severe mucosal inflammation and oedema, with lingular occlusion. The findings were suspicious of post-transplant lymphoproliferative disorder (PTLD) or atypical infection.Bronchial mucosal and supraclavicular nodal core biopsies both showed chronic inflammation with no features of PTLD. Calcofluor-white stain on endobronchial biopsy showed yeast cells embedded in inflammatory tissue. T. marneffei was isolated in blood, bronchial washings and lymph node cultures.Treatment was with intravenous then oral Voriconazole, and reduced immunosuppression, with significant improvement in CT findings and FEV1 at 2 months.Conclusion: This is a rare case of disseminated T. marneffei infection presenting with airway inflammation in a lung transplant recipient, with clinical findings mimicking PTLD. It demonstrates the importance of a thorough travel history and knowledge of endemic infectious diseases worldwide.