Invasive Talaromyces marneffei Fungemia in an HIV-Negative Patient with T-Prolymphocytic Leukaemia: A Case Report and Review of Emerging Risks.

BACKGROUND

Talaromyces marneffei (T. marneffei) is a thermally dimorphic fungus traditionally associated with HIV-related immunosuppression. However, increasing reports have described infections in HIV-negative patients with hematologic malignancies, particularly those receiving novel immunosuppressive therapies.

CASE PRESENTATION: We report a case of disseminated T. marneffei in an HIV-negative 55-year-old woman with T-prolymphocytic leukaemia (T-PLL) undergoing chemotherapy and targeted therapy with chidamide and golidocitinib. The patient presented with fever, pancytopenia, and signs of systemic infection. Blood cultures confirmed T. marneffei, with identification supported by dual-phase morphology and internal transcribed spacer (ITS) sequencing. Due to unavailability of amphotericin B, the patient was treated successfully with voriconazole, achieving rapid clinical improvement and negative follow-up cultures.

DISCUSSION: This case adds to the growing evidence that T. marneffei can cause invasive infections in non-HIV immunocompromised hosts. Through a review of 10 published cases, we identify common features such as neutropenia, kinase inhibitor use, and diagnostic delays. We emphasize the importance of early fungal culture and phase-specific morphology for diagnosis, and highlight voriconazole as a viable alternative therapy when amphotericin B is inaccessible.

CONCLUSION

Clinicians should maintain high suspicion for talaromycosis in immunosuppressed hematologic patients in endemic regions, regardless of HIV status. Prompt recognition and appropriate antifungal therapy are essential to improve outcomes.