A rare case report of Talaromyces marneffei in HIV/AIDS:numerous fungal spores on blood smears precipitate acute pancreatitis

Background Talaromyces marneffei (TM) is a thermally dimorphic fungus endemic to Southeast Asia and a major opportunistic pathogen in HIV/AIDS patients. We report a rare case of disseminated TM infection presenting with visible fungal spores 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 spores. Blood culture grew TM, confirmed by ITS sequencing. Despite antifungal therapy, the patient developed severe acute pancreatitis and multiorgan failure, and 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.