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

Abstract

HIV-infected individuals typically present with diverse clinical manifestations and heightened susceptibility to various opportunistic infections. We present a case of a hospitalized HIV patient presenting with dizziness, headache, and lip numbness. Neuroimaging revealed disseminated lesions involving bilateral cerebral hemispheres, spinal cord, pulmonary parenchyma, and mesenteric lymph nodes, subsequently confirmed through cerebrospinal fluid analysis and genetic testing as systemic TM infection. Following a 10-day course of intravenous amphotericin B, the patient demonstrated symptomatic improvement and was discharged. Post-discharge management included combination antiretroviral therapy (Bictegravir/Emtricitabine/Tenofovir alafenamide) with oral itraconazole prophylaxis. One-year follow-up imaging demonstrated near-complete resolution of systemic lesions. This report highlights characteristic radiological patterns and emphasizes the importance of considering disseminated TM infection in HIV patients with neurological involvement, particularly in endemic regions.

Keywords: CT; HIV; MRI; case report; multisystem infection; talaromyces marneffei.

Figure 1

(A and B) Bilateral cerebral hemispheres, cerebellum, and brainstem with multiple patchy low-signal lesions on T1WI, high signal on T2-FLAIR, and different degrees of edema around the lesions with marked edema (white arrows); (C and D) Post-contrast Magnetic resonance imaging showed nodular and ring-like enhancement, and no enhancement in the center of the lesion (white arrows); (E and F) DWI shows ring and point high signal shadows with reduced ADC values (white arrows). (G and H) MRI showed localized dilatation of the central canal of the cervicothoracic and thoracolumbar spinal cord, with abnormal signal lesions in the spinal cord (white arrows).

Figure 2

(A and B) Computed tomography scan showed multiple small nodular lesions in the upper lobe of the right lung and restrictive emphysema of both lungs in the lung and mediastinal windows on April 4, 2023 (white arrows); (C) Computed tomography scan showed new nodular lesions, and paraseptal emphysema in both upper lobes of both lungs in the lung windows on June 25, 2023, compared with the last chest CT examination (white arrows). (D) Abdominal CT scan showed multiple enlarged retroperitoneal lymph node lesions (white arrows).

Figure 3

The total length covered to the genome was 8446 (bp), the coverage was 0.0298%, and the average depth was 1.01X. The total length covered to the genome was 8446 (bp), the coverage was 0.0298%,and the average depth was 1.01X.

Figure 4

In 2024, MRI reexamination showed that multiple lesions in the brain and spinal cord were basically absorbed.

Figure 5

In 2024, abdominal CT reexamination showed that compared with before treatment, multiple abdominal lymph nodes disappeared.