Successful Rescue Therapy for Talaromycosis Complicated by Severe Acute Hepatorenal Failure with Hepatic Encephalopathy in an HIV/HCV-Coinfected Patient: A Case Report.

BACKGROUND: Treatment of critically ill patients with Talaromyces marneffei (T. marneffei, TM) infection involving multiple organ dysfunction remains a major clinical challenge. As an important contributor to mortality among individuals with Acquired Immunodeficiency Syndrome (AIDS), talaromycosis remains associated with mortality rates of up to 30% even with appropriate antifungal therapy. Severe hepatic and renal impairment may restrict antifungal dosing and thus further compromise therapeutic efficacy. However, current clinical evidence regarding the management of Talaromyces marneffei infection complicated by hepatic encephalopathy and acute renal failure remains limited.

CASE PRESENTATION: A 39-year-old female with a newly identified hepatitis C virus (HCV) infection and newly diagnosed Human Immunodeficiency Virus (HIV) infection was admitted to our hospital because of recurrent fever and abdominal pain. Abdominal ultrasound revealed hepatosplenomegaly, while chest and abdominal computed tomography scan showed bilateral pulmonary nodular lesions, multiple enlarged intra-abdominal and retroperitoneal lymph nodes, and splenomegaly. On the second day after admission, quantitative real-time polymerase chain reaction analysis of blood detected a T. marneffei load of 1.7 × 106 copies/mL, and disseminated talaromycosis was subsequently confirmed by blood culture. The patient therefore started on antifungal treatment with liposomal amphotericin B (L-AmB) at 3 mg/kg per day. Shortly after treatment initiation, she developed hepatic encephalopathy and acute renal failure and was transferred to the intensive care unit for further management. With the artificial liver support therapy and continuous renal replacement therapy (CRRT), full-dose L-AmB was maintained, allowing the patient to successfully completed the induction therapy with L-AmB. Her liver and renal function ultimately normalized, and the patient remained clinically stable with no evidence of T. marneffei recurrence at the one-year follow-up.

CONCLUSION: Early recognition of hepatorenal failure and timely initiation of CRRT combined with artificial liver support within 24 hours are essential for maintaining the antifungal effect of full-dose L-AmB.