Imaging findings of intracranial Talaromyces marneffei infection developing into multiple hemorrhagic infarcts: a case report

Abstract Case presentation: A 50-year-old female underwent spinal arachnoid adhesion lysis for hydrocephalus. Postoperatively, she developed progressive dizziness and limb weakness. Contrast-enhanced MRI revealed meningitis, and the patient was treated with piperacillin-tazobactam for one month. Follow-up imaging revealed striking enhancement of the skull base meninges, exhibiting a vividly characteristic Christmas-tree appearance. Furthermore, the study demonstrates irregular vessel wall thickening with contrast enhancement and associated luminal caliber irregularity. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) and blood samples confirmed infection with Talaromyces marneffei (T. marneffei) . Despite receiving liposomal amphotericin B at doses of 150 mg once daily therapy for two weeks, the patient’s consciousness failed to improve. She was discharged at the family’s request with a poor prognosis.