• De-Han Cai, Jun Wang, and Xiao-Lin Fang.
• Nephrology Department in Jiangxi Provincial People's Hospital Affiliated to Nanchang Medical College, Nanchang, Jiangxi, China.
• Medicine (Baltimore). 2022 Oct 7; 101 (40): e30958e30958.

RationaleTalaromyces marneffei causes life-threatening opportunistic fungal infections in immunocompromised patients. It often has a poorer prognosis in non-human immunodeficiency virus (HIV)-infected than in HIV-infected individuals because of delayed diagnosis and improper treatment.Patient ConcernsA 51-year-old man presented with complaints of pyrexia, cough, and expectoration that had lasted for 15 day. This patient has been taking anti-rejection medication since kidney transplant in 2011.DiagnosisT marneffei pneumonia; post renal transplantation; renal insufficiency; hypertension.InterventionsIntravenous moxifloxacin was administered on admission. After the etiology was established, moxifloxacin was discontinued and replaced with voriconazole. The tacrolimus dose was adjusted based on the blood concentration of tacrolimus and voriconazole.OutcomesThe patient was successfully treated and followed-up without recurrence for 1 year.LessonsA high degree of caution should be maintained for the possibility of T marneffei infection in immunodeficient non-HIV patients who live in or have traveled to T marneffei endemic areas. Early diagnosis and appropriate treatment can prevent progression of T marneffei infection and achieve a cure. Metagenomic next-generation sequencing (mNGS) can aid the physician in reaching an early pathogenic diagnosis. Close monitoring of tacrolimus and voriconazole blood levels during treatment remains a practical approach at this time.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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