AIDS-Associated Talaromyces marneffei Infection with Thoracic Spinal Cord Involvement Leading to Paraplegia: A Case Report and Literature Review

Background: Talaromyces marneffei is a common opportunistic infection in patients with acquired immune deficiency syndrome (AIDS) in South China. Spinal cord abscesses caused by T. marneffei are exceptionally rare and present with non-specific symptoms, which may result in delayed diagnosis and heightened adverse prognoses. Case Presentation: We report a case of a spinal cord abscess in a 30-year-old patient with AIDS that was caused by T. marneffei infection. The patient initially presented with T. marneffei septicemia and pleurisy. After initial antifungal treatment and combined antiretroviral therapy (cART), the patient's condition temporarily improved. However, he discontinued the antifungal treatment against medical advice and subsequently developed paraplegia, T. marneffei meningitis, and related intracranial and thoracic spinal cord lesions. Neurosurgical resection of the spinal cord lesion, combined with continued cART and antifungal treatment, resulted in the intracranial mass in the cerebellum resolving on MRI, but the patient remained non-ambulatory and incontinent during the last followup in August 2024. Conclusion: In patients with spinal cord abscesses and a history of disseminated T. marneffei infection, especially those with AIDS, talaromycosis should be considered as a potential differential diagnosis. Comprehensive management, encompassing adherence to treatment plans and effective follow-up, is crucial for improving prognosis.