A Case Report of Complex Co-infection with Talaromyces marneffei and Rhodococcus equi in a Patient with AIDS
Abstract
Abstract Background: Co-infection with Talaromyces marneffei (TM) and Rhodococcus equi in HIV-positive patients is an extremely rare but life-threatening combination of opportunistic infections. We report a scarce case of an HIV-infected patient initially suspected of pulmonary tuberculosis, who was subsequently confirmed by culture and next-generation sequencing (NGS) to have a co-infection with R. equi and TM. Case Presentation: The patient was a 32-year-old male presenting with cough, sputum production, and chest tightness after exercise. He was admitted to our hospital for further diagnosis and treatment on June 25, 2025. The sputum acid-fast stain was positive for acid-fast coccoid organisms on June 26, 2025. Following the confirmation of R. equi sepsis on June 27, the antimicrobial regimen was adjusted to a combination of levofloxacin (0.5g qd), amikacin (0.4g qd), and azithromycin (0.25g qd). On June 29, amphotericin B was initiated for anti-TM therapy, starting at 5 mg and titrated daily. Due to severe gastrointestinal reactions, azithromycin and compound sulfamethoxazole were discontinued. On June 30, the antiretroviral therapy (ART) was optimized to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TDF/3TC/DTG). On July 1, the patient reported three episodes of watery diarrhea; examination revealed white pseudomembranes on the bilateral oral mucosa, suggestive of concurrent oral candidiasis, for which sodium bicarbonate mouthwash was prescribed. At 11:30 on…
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