Fungemia caused by Penicillium marneffei in an immunocompetent patient with COPD: A unique case report

Abstract

Rationale: This report describes a rare case in Wenzhou city of Zhejiang province that a non-HIV infected male recovering from fungemia caused by Penicillium marneffei (P. marneffei). Interestingly, it's very easy to misdiagnose with aspergillosis, a fungal disease prevalent in Wenzhou, during the whole procedure.

Patient concerns: An 80-year-old Chinese male subject with pre-existing chronic obstructive pulmonary disease (COPD) presented with symptoms of chest tightness and high fever for a month.

Diagnoses: Fungal culture from the blood isolated P marneffei. Naturally, the patient was diagnosed with P marneffei fungemia. However, he was proven serologically to be negative for human immunodeficiency virus (HIV).

Interventions: The patient was treated with voriconazole at 200mg/dL every 12 hours via intravenous administration.

Outcomes: The fever returned to normal and chest tightness disappeared gradually after a week of voriconazole treatment.

Lessons: A high level of clinical suspicion and awareness is necessary for early diagnosis of P marneffei fungemia, especially in elder patients with underlying diseases.

Figure 1

A, B, CT scan of the lung showing (A) bilateral compressive atelectasis with large pleural effusions in lung window and (B) bilateral large layering pleural effusions in mediastinal window.

Figure 2

A, B, C, D fungal culture from blood showing (A) fried egg-like mold colony of P marneffei with a red diffusible pigment on Sabouraud Dextrose agar (after 10 days incubation at 25 °C) and (B) yeast colony of P marneffei (after 10 days incubation at 35 °C). The mold was smeared for Gram staining from blood culture showing (C) the red and rod-shaped hyphae (red arrow). Lacto-phenol cotton blue stain of P marneffei revealed (D) paintbrush-like clusters hyphae and conidiophores.