HIV infection complicated with talaromyces marneffei, tuberculosis, hemophagocytic lymphohistiocytosis and non-Hodgkin lymphoma: a complex case report

Due to severe immunosuppression, human immunodeficiency virus (HIV) infected individuals are prone to multiple opportunistic infections and malignancies. This report presents a complex case of a 62-year-old male HIV patient who was diagnosed with co-infections of Talaromyces marneffei, tuberculosis, hemophagocytic lymphohistiocytosis (HLH), and ultimately non-Hodgkin B-cell lymphoma. This case provides valuable insights for clinical diagnosis and treatment. The patient was admitted with complaints of “poor appetite, weight loss, and diarrhea for two weeks, accompanied by fever for four days.” Upon admission, the patient was diagnosed with HIV infection, with a CD4 + T-cell count of only 25/µL. Pathological examination of cervical lymph node aspiration and metagenomic next-generation sequencing (mNGS) confirmed infections with Talaromyces marneffei, Mycobacterium tuberculosis, and Aspergillus species. During treatment, the patient developed persistent high fever, pancytopenia, decreased fibrinogen, and significantly elevated ferritin levels. Abdominal computed tomography (CT) revealed splenomegaly. Further bone marrow examination confirmed HLH, and symptoms improved after treatment with glucocorticoids and immunoglobulin. However, the patient’s condition further deteriorated, and positron emission tomography computed tomography (PET-CT) along with repeat lymph node biopsy confirmed the diagnosis of non-Hodgkin B-cell lymphoma. Under combined antifungal, anti-tuberculosis, antiretroviral therapy (ART), and chemotherapy, the patient showed clinical improvement. This case highlights the complexity and challenges in diagnosing and managing multiple opportunistic infections and malignancies in advanced HIV patients. It underscores the importance of multidisciplinary collaboration and provides valuable experience for the clinical management of HIV-related opportunistic infections and malignancies.