Division of Infectious Disease, Department of Internal Medicine, National Medical Center, Seoul, Korea.
J Korean Med Sci. 2012 Jun;27(6):697-700. doi: 10.3346/jkms.2012.27.6.697. Epub 2012 May 26.
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.
马尔尼菲青霉可引起免疫功能低下患者发生危及生命的系统性真菌感染，且该病在东南亚流行。一名 39 岁的 HIV 感染男性，居住在老挝，出现发热、咳嗽和颜面部水疱性脓疱样皮损，皮损已出现两周。CT 扫描显示双肺双侧微结节；支气管镜活检发现卡氏肺孢子菌。尽管给予复方磺胺甲噁唑和抗结核药物治疗，但肺部病变仍进展，面部皮损出现中央脐凹。皮肤病变活检证实为播散性马尔尼菲青霉病，培养显示马尔尼菲青霉菌丝和孢子。rRNA PCR 鉴定为马尔尼菲青霉。对支气管镜活检的回顾性检查提示为青霉病。给予两性霉素 B 治疗并接受抗反转录病毒治疗后，患者完全康复。这是首例韩国 HIV 感染患者的马尔尼菲青霉病。当免疫功能低下且有流行地区旅行史的患者出现呼吸道疾病时，需要考虑马尔尼菲青霉。
