Immunosuppression resulted from HIV infection often allows opportunistic microbial infections and malignancies in AIDS patients. Concurrence of talaromycosis and Kaposi sarcoma, however, seems to be rare, with a recent study reporting low prevalence of each conditions 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, may suggest a high risk of mortality . In the only study that reported the concurrence of talaromycosis and Kaposi sarcoma in HIV-infected patients, 2 out of 3 patients died; important clinical information, including disease features and management strategies was not discussed in that study .
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 presented 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 Kaposi sarcoma, that was subsequentially confirmed 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 significantly resolved upon the initiation 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 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 . No further investigation was carried out in this study to clarify the cause of severe pulmonary symptoms, that is an obvious limitation.
High mortality rate of HIV-infected patients with comorbid talaromycosis and Kaposi sarcoma has been linked to low CD4 T-cell count and hemoglobin level . 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. The patient rapidly recovered after timely ART, 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. Cautions should be taken when seeing HIV-infected patients suspected of such severe comorbid conditions. Timely etiological investigation, diagnosis, and treatment are the key to successful management of the patient.