HIV Complicated with Talaromyces Marneffei Multisystem Infection: A Case Report and Literature Review

Area of Science:

• Mycology
• Infectious Diseases
• Neurology

Background:

• Human Immunodeficiency Virus (HIV) infection compromises the immune system, increasing susceptibility to opportunistic infections.
• Talaromyces marneffei (TM) infection is an endemic mycosis prevalent in Southeast Asia, posing a significant threat to immunocompromised individuals.

Observation:

• A hospitalized HIV patient presented with neurological symptoms including dizziness, headache, and lip numbness.
• Neuroimaging revealed disseminated lesions across the brain, spinal cord, lungs, and mesenteric lymph nodes.
• Cerebrospinal fluid analysis and genetic testing confirmed systemic TM infection.

Findings:

• Intravenous amphotericin B treatment for 10 days resulted in symptomatic improvement and discharge.
• Combination antiretroviral therapy (Bictegravir/Emtricitabine/Tenofovir alafenamide) and oral itraconazole prophylaxis were initiated post-discharge.
• One-year follow-up imaging showed near-complete resolution of disseminated TM lesions.

Implications:

• Disseminated TM infection should be considered in HIV patients presenting with neurological symptoms, especially in endemic areas.
• Characteristic radiological patterns can aid in early diagnosis of systemic TM infection.
• Prompt diagnosis and integrated treatment (antifungal and antiretroviral therapy) are crucial for favorable outcomes in HIV-associated TM infections.