Volume 21, Number 7—July 2015
CME ACTIVITY - Synopsis
Disseminated Infections with Talaromyces marneffei in Non-AIDS Patients Given Monoclonal Antibodies against CD20 and Kinase Inhibitors
Jasper F.W. Chan, Thomas S.Y. Chan, Harinder Gill, Frank Y.F. Lam, Nigel J. Trendell-Smith, Siddharth Sridhar, Herman Tse, Susanna K.P. Lau, Ivan F.N. Hung, Patrick C.Y. Woo, and Kwok-Yung Yuen
Table 1
Characteristics of 4 case-patients with disseminated Talaromyces marneffei infection after targeted therapies*
| Characteristic | Case-patient 1 | Case-patient 2 | Case-patient 3 | Case-patient 4 |
|---|---|---|---|---|
| Age, y/sex | 56/M | 44/M | 63/M | 67/M |
| Concurrent conditions | Waldenström macroglobulinemia, idiopathic thrombocytopenic purpura, primary biliary cirrhosis | Chronic lymphocytic leukemia | Myelofibrosis with splenectomy, diabetes mellitus | Acute myeloid leukemia, hypertension |
| Targeted therapy | Rituximab | Rituximab and obinutuzumab | Ruxolitinib | Sorafenib |
| Action of therapy | mAb against CD20 | mAb against CD20 | JAK-1/2 inhibitor | Multikinase inhibitor |
| Time interval, mo† | 18 | 14 (rituximab) and concomitant (obinutuzumab) | Concomitant | Concomitant |
| Cumulative dose before T. marneffei infection | 700 mg/dose iv x 4 doses | 700 mg/dose IV x 13 doses (rituximab) and 1,000 mg IV x 3 doses (obinutuzumab) | 10–20 mg 2×/d oral x 6.5 mo | 400 mg 2×/d oral x 8 mo |
| Other immunosuppressants (time interval, mo)† | Fludarabine and dexamethasone (39), prednisolone 10 mg/d and mycophenolate sodium 360 mg 2×/d (concomitant) | Fludarabine and cyclophosphamide (48), CHOP (36), bendamustine (13) | None | Mitoxantrone and etoposide (21), daunarubicin (20), clofarabine (18), azacitidine (15), decitabine (15), cytarabine (14) |
| Clinical manifestations | Terminal ileitis, cerebral abscesses, nasopharyngitis, and multiple cavitary lung lesions | Marrow infiltration and fungemia | Right cervical lymphadenitis and multiple cavitary lung lesions | Fungemia |
| Specimens positive for T. marneffei | Feces, and terminal ileal and nasopharyngeal biopsy specimens | Blood and bone marrow aspirate | Right cervical lymph node | Blood |
| Highest serum antibody titer against T. marneffei | 1:320 | <1:40 | 1:320 | <1:40 |
| Antifungal treatment (duration, mo) | Amphotericin B (2 weeks) and voriconazole (>21) | Amphotericin B (2 weeks) and itraconaozle (5) | Amphotericin B (2 weeks) and voriconazole (>6) | Amphotericin B (2 weeks) and voriconazole (>5) |
| Other opportunistic infections | None | Bacteremia (Mycobacterium chelonae, Enterococcus faecium, and MRCNS), fungemia (Candida glabrata), HSV oral mucositis, PJP | Bacteremia (Klebsiella pneumoniae) | Herpes zoster at right occiput |
| Clinical outcome | Responded to antifungal treatment | Clearance of T. marneffei fungemia but died of MODS and multiple infections 5 mo after T. marneffei infection | Responded to antifungal treatment | Responded to antifungal treatment |
*mAb, monoclonal antibody; JAK, Janus kinase; IV, intravenous; CHOP, cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone; MRCNS, methicillin-resistant coagulase-negative Staphylococcus; HSV, herpes simplex virus; PJP, Pneumocystis jiroveci pneumonia; MODS, multiple organ dysfunction syndrome.
†Time interval between end of therapy and onset of symptoms for T. marneffei infection.
Page created: July 14, 2015
Page updated: July 14, 2015
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