Invasive fungal infections are among the most severe conditions affecting patients with hematologic malignancies, with the most common etiologic agents being Candida spp., Aspergillus spp., Rhizopus spp., Pneumocystis jirovecii , and Fusarium spp. We report a case of coinfection with HIV and tuberculosis, with a recent diagnosis of acute myeloid leukemia (AML), evolving with invasive fungal infection due to Magnusiomyces capitatus , an uncommon pathogen. Patient EMIGS, 54-year-old female, living with HIV/AIDS since 2005, virologically suppressed with immunologic recovery, on a simplified antiretroviral regimen since September 2023. Hospitalized in April 2024 for investigation of a consumptive syndrome with afternoon fever, dry cough, disseminated lymphadenopathy, and bicytopenia (anemia and neutropenia) for 20 days. Excisional lymph-node biopsy showed detectable TB by molecular test; rifampicin, isoniazid, ethambutol, and pyrazinamide were initiated. Bone-marrow studies confirmed AML. Chemotherapy began in June 2025; due to drug interaction between voriconazole and rifampicin, micafungin was chosen for antifungal prophylaxis. Seven days after starting chemotherapy, the patient developed neutropenic colitis and progressed to septic shock. Blood cultures yielded yeast growth despite echinocandin use; therapy was switched to liposomal amphotericin B. The patient died; M. capitatus was later identified in culture. The advent of high-barrier antiretroviral regimens has reduced opportunistic infections in PLHIV and increased comorbidities seen in the general population, including non-HIV-associated neoplasms and their complications. M. capitatus is an emerging pathogen in immunocompromised patients and shows intrinsic in vitro resistance to echinocandins, with high rates of fluconazole resistance. Moreover, HIV-tuberculosis coinfection remains a leading cause of death in this population. New and classic diagnoses in PLHIV coexist and should always be investigated.
Póvoa et al. (Sun,) studied this question.