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Volume 21, Number 7—July 2015

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 YuenComments to Author 
Author affiliations: The University of Hong Kong, Hong Kong, China

Main Article

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.

Main Article

Page created: July 14, 2015
Page updated: July 14, 2015
Page reviewed: July 14, 2015
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