Systemic Penicillium marneffei infection in a child with common variable immunodeficiency

Penicillium marneffei is rarely pathogenic in humans. Most previously repor ted cases of P. marneffei infection were from Southeast Asia where patients were usually in an immunocompromised state due to human immunodeficiency v irus (HIV) infection. The majority of the patients reported in Western coun tries were immunocompromised by malignancy, especially Hodgkin's lymphoma. In Taiwan, the first case of P. marneffei infection was reported in 1994 an d involved an adult with HIV infection. We report a case of systemic P. mar neffei infection in a child with common variable immunodeficiency (CVID). T he patient, a 4-year, 5-month-old boy, had a 1-year history of oligoarthrit is resembling juvenile rheumatoid arthritis (JRA). Ile developed a low grad e fever (38 degrees C) and hepatosplenomegaly 1 month before admission to t he hospital. Although cultures of synovial fluid obtained at the time of on set of oligoarthritis did not grow any organisms, cultures of blood, bone m arrow, synovial fluid, and lymph node biopsy samples taken during this admi ssion were positive for P. marneffei. Further immunologic studies revealed a profile characteristic of CVID. The fungal infection was finally eradicat ed by combined therapy with amphotericin B. fluconazole, itraconazole, and regular immunoglobulin replacement. This case reminds us that JRA or JRA-li ke arthritis should be differentiated from septic arthritis caused by rare pathogens in immunocompromised patients.