Clinical analysis of HIV co-infection with Talaromyces marneffei complicated by hemophagocytic syndrome.

OBJECTIVE: To analyze the clinical characteristics, diagnostic challenges, treatment strategies, and prognosis of patients co-infected with human immunodeficiency virus (HIV) and disseminated Talaromyces marneffei (TM), complicated by Hemophagocytic Lymphohistiocytosis (HLH), with the aim of improving early recognition and comprehensive diagnosis and treatment. METHODS: Three adult inpatients diagnosed with acquired immunodeficiency syndrome (AIDS), TM infection, and HLH between January 2020 and December 2025 at the Fourth People's Hospital of Nanning were enrolled in this study. Demographic characteristics, clinical symptoms, laboratory findings, imaging results, and treatment outcomes were collected from the hospital's electronic medical record system. RESULTS: All three patients (2 males, 1 female) presented with multi-system involvement. Common symptoms included fever, cough, and anemia. All cases met five core diagnostic criteria for HLH. Laboratory tests indicated pancytopenia, elevated inflammatory markers, and multi-organ dysfunction. Chest computed tomography (CT) scans revealed pulmonary infiltrates, lymphadenopathy, and serous cavity effusions in all patients. Treatment consisted of antifungal therapy with amphotericin B combined with itraconazole, and all patients received corticosteroids for HLH management. Two patients improved and were discharged, while one died due to poor baseline condition and multi-organ failure. Hospitalization duration ranged from 23 to 144 days, with no significant adverse drug reactions observed during treatment. CONCLUSION: The clinical manifestations of HIV co-infected with TM and HLH may be atypical. Diagnosis should focus on key indicators such as fever, cytopenia, and hyperferritinemia, with prompt bone marrow examination. Effective treatment requires potent antifungal agents, tailored immunosuppressive therapy, and enhanced organ support.