Unusual pulmonary manifestations of disseminated Penicillium marneffei infection in three AIDS patients

Penicillium marneffei is a rare fungal pathogen which can cause human infec tions in people predominantly living in South-east Asia and the southern po rtion of China. We report three cases of systemic P. marneffei infection in patients infected with HIV who lived in or had travelled to endemic areas. The clinical manifestation includes high fever, chills, weight loss, gener al malaise, chronic cough, haemoptysis, multiple skin lesions, abnormal liv er function, etc. Chest X-ray showed single or multiple cavitary lesions wi th smooth or irregular thin wall. P. marneffei is cultured from blood, sput um, skin biopsy, sono-guide aspiration and bronchoscopic biopsy. After anti fungal therapy with intravenous amphotericin B or oral fluconazole, skin le sions resolved completely within 2 weeks and cavitary lesions in the lungs changed to chronic fibrotic and interstitial processes after several months to a few years later. Our two cases had been treated as either pulmonary t uberculosis or suspected malignancy. A definite diagnosis and early treatme nt are important because this fungal infection is a marker of AIDS in South -east Asia.