Immunosuppression resulted from HIV infection often allows opportunistic microbial infections and malignancies in AIDS patients. Concurrence of talaromycosis and Kaposi sarcoma, however, seemed to be rare, with a recent study reporting low prevalence of individual condition in HIV-infected patients in China (1.4% for talaromycosis and 0.8% for Kaposi sarcoma) . Coexistence of these two conditions, though being a rare event, might suggest high risk of mortality . In the only study that described the concurrence of talaromycosis and Kaposi sarcoma in HIV-infected patients, 2 out of 3 patients died; other important clinical information, including disease features and management strategies was not described or discussed .
Kaposi sarcoma is a malignant vascular tumor frequently found in HIV-infected patients  and has been linked to human gammaherpesvirus 8 . Diagnosis of Kaposi sarcoma mainly relies on clinical manifestations and histopathological examination. Radiographic characteristics of pulmonary Kaposi sarcoma are non-specific, often presenting as nodules, pleural effusions, hilar or mediatinal lymphadenopathy, and patchy shadows . In this case, the patient’s chest CT showed multiple nodules and infiltrates in the bilateral lungs, in combination with purple rashes in his feet and violaceous plaques in the oral cavity, suggesting a possibility of pulmonary Kaposi sarcoma, that was subsequentially supported by histopathological analysis of skin biopsies. Highly active antiretroviral therapy(HAART)is the recommended treatment for HIV-infected patients with Kaposi sarcoma . Oral plaques, foot rashes and respiratory tract symptoms of the patient all significantly resolved upon the use of HAART. Relief of respiratory symptoms of this patient, along with remarkable pulmonary improvement on the Chest CT, however, could also be owing to antifungal therapy for talaromycosis. Talaromycosis is a common opportunistic infection that often occurs in the respiratory system of HIV-infected patients in southern and eastern China [3, 7]. Patients with talaromycosis may also present fever, cough, sputum expectoration, skin rash, and lymphadenopathy , and have non-specific hilar or mediastinal lymphadenopathy and multiple nodular on the chest CT . Talaromycosis often progress rapidly in HIV-infected patients and also has a high mortality rate if antifungal treatment is delayed .
High mortality rate of the concurrence of these conditions in HIV-infected patients has been linked to low CD4 T-cell count and hemoglobin level . Caution should be taken when seeing HIV-infected patients suspected of concurrent talaromycosis and Kaposi sarcoma. Although our patient had a normal hemoglobin level of 126 g/L, a very low CD4 T-cell count of 1 cell/mm3 suggested a high mortality risk. Timely etiological investigation, diagnosis, and treatment were the key to successful management. The patient rapidly recovered after timely HAART and antifungals were given. Although Amphotericin B is the recommended antifungal drug for induction therapy for patients with talaromycosis , Itraconazole alone was used for this patient due to his moderate clinical symptoms .
In conclusion, Kaposi sarcoma and talaromycosis may concur in patients with HIV, due to their immunodeficient status. Etiological investigation and specifically directed treatment are required for patients suspected of such severe comorbid conditions.