A haemato-neuro-renal diagnostic challenge in advanced HIV: multiple opportunistic infections including novel Mycobacterium chelonae pyelonephritis and HIV-associated neurocognitive disorder with myelopathy.

Advanced HIV disease predisposes individuals to a wide and often concurrent spectrum of complications arising from opportunistic infections, immune dysregulation, direct viral injury, and treatment effects. In tuberculosis-endemic, resource-limited settings, disseminated tuberculosis frequently dominates clinical reasoning for multisystem disease in profoundly immunosuppressed patients - a cognitive default that risks failing to identify concurrent, independently treatable conditions. We describe a 35-year-old man with advanced HIV infection from central India who simultaneously developed parvovirus B19-associated marrow suppression, xanthogranulomatous pyelonephritis due to co-infection with carbapenem-resistant Escherichia coli and Mycobacterium chelonae, and symptomatic HIV-associated neurocognitive disorder (HAND) with myelopathy. To our knowledge, this represents the first reported case of M. chelonae pyelonephritis in a patient with HIV infection. This case report describes the diagnostic considerations for advanced HIV presenting as concurrent multisystem disease in a tuberculosis-endemic, resource-limited setting, and the clinical consequences of moving beyond the presumption of a single unifying aetiology.