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Corresponding author: Jianquan Zhang, Department of Respiratory and Critical Care Medicine, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong 518033, China, Tel: +86 139 7812 3845; Fax: +86 0755 83982222
A 54-year-old man with diabetic nephropathy underwent kidney transplantation five years ago. He was receiving tacrolimus and mycophenolate mofetil and presented with a two-week history of sore throat and odynophagia. He had elevated leukocyte count, C-reactive protein level, and erythrocyte sedimentation rate; low B lymphocyte percentage; and anemia and hypoproteinemia. Magnetic resonance imaging showed thickened left vocal cords (Figure 1). Indirect laryngoscopy revealed new gray-white organisms on the left arytenoid cartilage side and ulcers of varied sizes in the oropharynx and laryngopharinx (Figure B). Initially, he was diagnosed with Mycobacterium tuberculosis laryngitis. However, histopathologic evaluation of the larynx tissue biopsy, next-generation bronchoalveolar lavage fluid sequencing, and cultures of the sputum and bronchoalveolar lavage fluid revealed Talaromyces marneffei (Figure C). He received antifungal therapy of intravenous voriconazole (200 mg, twice a day, 7 days), followed by oral voriconazole administration. His symptoms entirely resolved without complications. We monitored the plasma tacrolimus and voriconazole concentrations during the adjusting medication course. No talaromycosis relapse was observed in the 6-month follow-up period.
Figure 1The left vocal cords were thickened with a local abnormal signal. Figure B: Indirect laryngoscopy revealed laryngopharyngeal ulcers. Figure C: Bronchoalveolar lavage fluid fungal culture at 25°C, demonstrating white to tan-colored, velvety, flat colonies with a red soluble pigment.
Post-transplant immunomodulatory use is a risk factor of multiple opportunistic infections. Kidney transplantation talaromycosis, presenting with ulcers of the oropharynx and laryingopharinx and thickened vocal cords was first reported (
The authors have no competing interests to declare.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical approval statement
This study was approved by The Eighth Affiliated Hospital of Sun Yat-Sen University Ethics Committee. Written informed consent, permissions, and releases were obtained from the patient for publication of this article and for any patient details, information, and images. The written consents are available for review by the editor.
References
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A retrospective analysis of seven patients with acquired immunodeficiency syndrome and pharyngeal and/or laryngeal Talaromyces marneffei infection.
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