Background: Concurrence of talaromycosis, an infection caused by the opportunistic fungal pathogen Talaromyces marneffei and Kaposi sarcoma, a common vascular tumor, is a rare but severe medical condition in patients infected with the human immunodeficiency virus (HIV). Despite poor outcomes, the clinical characteristics and management strategies for HIV-infected patients with comorbid Kaposi sarcoma and talaromycosis have not been well documented.

Case presentation: A 33-year-old HIV-positive male patient presented to the Department of Infectious Diseases at Wenzhou Central Hospital with cough, sputum expectoration, hemoptysis, rashes on the feet and violaceous plaques in the oral cavity. Chest computed tomography (CT) showed bilateral nodules, patchy shadows and lymphadenectasis. Skin biopsy and histopathological examination indicated Kaposi sarcoma. T. marneffei was isolated from blood cultures and suggested talaromycosis. The patient’s overall conditions significantly improved following initiation of combination antiretroviral therapy (cART) and chemotherapy for Kaposi sarcoma and antifungal treatment for talaromycosis.

Conclusion: Severe medical conditions such as Kaposi sarcoma and talaromycosis may coexist in HIV-infected patients and pose an increased risk of mortality. Etiological diagnosis and treatment are the keys to the successful management of HIV-infected patients with these concurrent conditions.

背景：踝节菌病是一种由机会性真菌病原体马尔尼菲踝节菌和卡波西肉瘤（一种常见的血管肿瘤）引起的感染，是人类免疫缺陷病毒 (HIV) 感染患者的一种罕见但严重的疾病。尽管结果不佳，但 HIV 感染患者的卡波西肉瘤和踝关节病合并症的临床特征和管理策略尚未得到充分记录。

病例介绍： 一名 33 岁 HIV 阳性男性患者，因咳嗽、咳痰、咯血、足部皮疹和口腔内紫红色斑块就诊于温州市中心医院感染科。胸部计算机断层扫描 (CT) 显示双侧结节、斑片状阴影和淋巴结肿大。皮肤活检和组织病理学检查提示卡波西肉瘤。T. marneffei 从血培养中分离出来，提示有踝关节菌病。在开始联合抗逆转录病毒疗法 (cART) 和化学疗法治疗卡波西肉瘤以及抗真菌治疗踝关节病后，患者的整体状况显着改善。

结论：卡波西肉瘤和踝关节病等严重疾病可能在 HIV 感染患者中并存，并增加死亡风险。病因诊断和治疗是成功管理具有这些并发状况的 HIV 感染患者的关键。