Abstract: Objective To explore the clinical features and CT imaging characteristics of AIDS complicated by Talaromycosis marneffei (TSM) and splenic tuberculosis (STB), aiming to enhance the diagnostic and differential diagnostic capabilities of both conditions. Method A retrospective analysis was conducted on clinical and abdominal CT data of 22 patients with AIDS complicated by TSM and 31 patients with AIDS complicated by STB, diagnosed at the Fourth People's Hospital of Nanning between January 2019 and December 2023. The clinical features (age, gender, CD4⁺T lymphocyte count, anemia, fever, abdominal distension, abdominal pain, and skin rash) were compared between the two groups. CT manifestations, including spleen size, classification and enhancement patterns of splenic lesions, involvement and enhancement patterns of abdominal and retroperitoneal lymph nodes, and presence of splenic infarction, were also evaluated. Result Patients with splenic TSM typically had lower CD4⁺T lymphocyte counts, with counts below 20 cells/μl being more prevalent. Skin rash and abdominal distension were more frequent in splenic TSM patients compared to those with splenic STB. No statistically significant differences were observed in gender, age distribution, or incidence of anemia, fever, and abdominal pain between the groups. The CT imaging of splenic TSM patients predominantly revealed abscess/mass-type lesions, while STB patients more commonly presented with miliary or nodular patterns. There was no significant difference in splenomegaly and splenic infarction between the two groups. Splenic TSM typically demonstrated no enhancement on enhanced CT scans, while STB often exhibited ring enhancement. Both groups frequently showed abdominal and retroperitoneal lymphadenopathy, with TSM-related lymphadenopathy often displaying homogeneous enhancement and tuberculous lymph nodes primarily showing ring enhancement. Conclusion AIDS patients with splenic TSM and STB demonstrate distinct clinical and CT manifestations. Contrast-enhanced CT plays a crucial role in the diagnosis and differentiation of these conditions. A comprehensive understanding of the clinical and CT features of AIDS complicated by splenic TSM and STB can significantly improve diagnostic accuracy and differentiation.

Key words: Acquired immune deficiency syndrome, Talaromycosis marneffei, Splenic tuberculosis, Clinical features, Computed tomography