HEPATIC PENICILLIOSIS IN PATIENTS WITHOUT SKIN-LESIONS

Penicillium marneffei is a common cause of opportunistic fungal infect ion in patients with AIDS in Thailand. The diagnosis of penicilliosis is easily made when typical skin lesions appear but is frequently miss ed in their absence. We therefore attempted to identify noncutaneous i ndicators of P. marneffei infection in order to provide early curative treatment. We recognized a characteristic syndrome in six AIDS patien ts with penicilliosis involving primarily the liver but not the skin w ho presented with fever of short duration, hepatomegaly, and markedly elevated serum alkaline phosphatase levels. The diagnosis was confirme d by demonstrating the causative organism in the liver or in the blood . Increased awareness of hepatic penicilliosis and more-rapid diagnost ic methods are needed to reduce the high mortality rate associated wit h this syndrome. P. marneffei is predominantly an Asian pathogen, but as a result of international travel, the need for increased awareness of penicilliosis is worldwide.