Talaromyces Marneffei Infection Involving the Central Nervous System in a Patient with Acquired Immunodeficiency Syndrome: A Case Report and Literature Review.

Background: Talaromycosis, an opportunistic deep invasive mycosis, is caused by the fungus Talaromyces marneffei and is predominantly observed in individuals with acquired immunodeficiency syndrome (AIDS). Involvement of the central nervous system (CNS) is exceedingly rare and presents significant diagnostic challenges, often associated with high mortality rates.

Case presentation: This report details a case of CNS Talaromyces marneffei infection in an AIDS patient who initially presented with epileptic seizures. Neuroimaging identified a ring-enhancing lesion within the right frontal lobe, concurrent with a marked elevation in serum β-D-glucan levels. The diagnosis was confirmed through a multimodal approach, including histopathological examination and metagenomic next-generation sequencing (mNGS). Postoperative management involved a sequential regimen of amphotericin B followed by voriconazole, leading to a favorable recovery. The patient is currently on a maintenance elvitegravir-based antiretroviral therapy regimen.

Conclusions: CNS Talaromyces marneffei infection in AIDS patients often lacks specific clinical manifestations, which complicates diagnosis and treatment. This case report contributes to the existing body of knowledge by presenting a successfully managed case, thereby enhancing the understanding of diagnostic and therapeutic strategies for similar future presentations.