Disseminated penicilliosis in a Korean human immunodeficiency virus infected patient from Laos

Abstract

Penicillium marneffei may cause life-threatening systemic fungal infection in immune-compromised patients and it is endemic in Southeast Asia. A 39-yr-old HIV-infected male, living in Laos, presented with fever, cough, and facial vesiculopapular lesions, which had been apparent for two weeks. CT scans showed bilateral micronodules on both lungs; Pneumocystis jirovecii was identified by bronchoscopic biopsy. Despite trimethoprim-sulfamethoxazole and anti-tuberculosis medications, the lung lesions progressed and the facial lesions revealed central umbilications. Biopsy of the skin lesions confirmed disseminated penicilliosis, with the culture showing P. marneffei hyphae and spores. The P. marneffei was identified by rRNA PCR. A review of the bronchoscopic biopsy indicated penicilliosis. The patient completely recovered after being prescribed amphotericin-B and receiving antiretroviral therapy. This is the first case of penicilliosis in a Korean HIV-infected patient. It is necessary to consider P. marneffei when immunocompromised patients, with a history of visits to endemic areas, reveal respiratory disease.

Keywords: Disseminated Infection; HIV/AIDS; Korean; Penicillium marneffei.

Fig. 1

Clinical features of disseminated P. marneffei infection. (A) Initial chest CT findings. Bilaterally distributed multiple small nodules and consolidation with ground-glass opacity pattern were observed in dependent portions. (B) Skin lesions one week after admission. Multiple erythematous papular lesions in forehead revealed central umbilication.

Fig. 2

Penicillium marneffei cultured at 25℃ on Sabouraud dextrose agar plate. (A) Gross findings of culture. Colonies revealed distinctive red diffusible pigment and the surface was powdery and gray-green with a white border. (B) Microscopic findings. Lactophenol cotton blue stain preparation from colony revealed metulae and conidia of Penicillium marneffei.