A rare case report of disseminated Talaromyces marneffei infection presenting as acute pancreatitis in an HIV-1 infected patient.

BACKGROUND: Talaromyces marneffei (TM) is a thermally dimorphic fungus endemic to Southeast Asia and a major opportunistic pathogen in HIV-1/AIDS patients. We report a rare case of disseminated TM infection presenting with yeast-like fungal structures on peripheral blood smear and complicated by acute pancreatitis. CASE PRESENTATION: A 52-year-old man with AIDS (CD4+ count: 134 cells/μL) presented with prolonged fever, cough, and weight loss. Peripheral blood smear revealed numerous yeast-like fungal structures. Blood culture grew TM, confirmed by ITS sequencing(GenBank accession number: PX499650).Despite antifungal therapy, the patient developed severe acute pancreatitis(lipase 1746.9 U/L, > 3 times the upper limit of normal)and multiorgan failure.Extensive investigations excluded common infectious and non-infectious etiologies.The patient died on day 7.This is the first reported case of TM-induced acute pancreatitis likely triggered by fungal microembolization. CONCLUSIONS: TM should be considered in HIV patients with unexplained pancreatitis, especially in endemic areas. Peripheral blood smear may serve as a rapid diagnostic clue in disseminated infection,indicating potential organ involvement that may affect uncommon sites.