Disseminated talaromycosis with pulmonary tuberculosis coinfection in an immunocompromised patient mimicking disseminated histoplasmosis

Opportunistic infections in patients with human immunodeficiency virus (HIV) can mimic each other, complicating diagnosis. Here, we report a rare case of disseminated Talaromyces marneffei in a 39-year-old immunocompromised male with HIV and pulmonary tuberculosis. The patient had respiratory symptoms, systemic manifestations, and skin lesions. Clinical and pathological investigations suggested disseminated histoplasmosis; however, microbiological culture confirmed the diagnosis of disseminated talaromycosis. Imaging confirmed central nervous system involvement. Treatment with amphotericin B led to significant initial clinical improvement; however, eventually the patient succumbed to his illness. This case highlights the importance of maintaining a high level of clinical suspicion and early detection, especially in endemic regions. Awareness among clinicians can improve outcomes in immunocompromised individuals by ensuring timely antifungal therapy.