Hall Charlotte, Hajjawi Rachel, Barlow Gavin, Thaker Hiten, Adams Kate, Moss Peter
Department of Infection and Tropical Medicine, Hull and East Yorkshire NHS Trust, Cottingham, East Riding of Yorkshire, UK.
BMJ Case Rep. 2013 Jan 28;2013:bcr2012007555. doi: 10.1136/bcr-2012-007555.
A 62-year-old British man with advanced HIV was established on antiretroviral therapy and treatment for disseminated Mycobacterium avium complex and Cytomegalovirus infections. One month later he re-presented with epigastric pain, an epigastric mass and skin lesions. Abdominal imaging revealed large volume lymphadenopathy, which was not present on previous imaging. Blood cultures yielded Penicillium marneffei, a dimorphic fungus endemic to South-east Asia. The patient had spent several years travelling in Thailand prior to the diagnosis of HIV. Penicilliosis is a common AIDS-defining illness in endemic areas, but remains rare in Europe. In this case, it presented in the context of a rapidly decreasing viral load as an immune reconstitution inflammatory syndrome. The challenges of management in the context of multiple comorbidities and polypharmacy are discussed.
一名62岁的英国晚期艾滋病男性患者正在接受抗逆转录病毒治疗，并接受播散性鸟分枝杆菌复合体和巨细胞病毒感染的治疗。一个月后，他再次出现上腹部疼痛、上腹部肿块和皮肤病变。腹部影像学检查发现大量淋巴结肿大，之前的影像学检查未发现此情况。血培养发现马尔尼菲青霉菌，这是一种东南亚特有的双相真菌。该患者在诊断出艾滋病之前曾在泰国旅行数年。马尔尼菲青霉病在流行地区是一种常见的艾滋病界定疾病，但在欧洲仍然罕见。在这种情况下，它在病毒载量迅速下降的背景下表现为免疫重建炎症综合征。本文讨论了在多种合并症和多种药物治疗情况下的管理挑战。
