Disseminated Penicillium marneffei infection in an HIV-positive female from Thailand in Germany

We report the case of a 33 year old Thai female, who was married in Germany for eight years and used to travel to Thailand every year for several week s. She presented with abdominal and back pain, prolonged fever, generalized lymphadenopathy, and a recent history of oral thrush. She was diagnosed HI V positive with initial CD4 counts of 18/mu l and an HI virus load of 59.00 0 copies/ml. Antiviral therapy was installed with zidovudin, lamivudin, and efavirenz. Abdominal CT scans revealed greatly enlarged abdominal lymphnod es. Fine needle aspirates of cervical and retroperitoneal lymphnodes, sputu m samples, blood samples, and a bone marrow biopsy were microscopically pos itive for Penicillium marneffei and grew P. marneffei. The isolates were se nsitive to amphotericin B, flucytosine, itraconazole, and fluconazole. Both universal and specific fungal polymerase chain reaction assays were positi ve in various samples. Serum Aspergillus galactomannan antigen, which is kn own to crossreact with P. marneffei, was elevated and subsequently used for monitoring of therapy. With antifungal treatment (intravenous amphotericin B 0.6 mg/kg/d for two weeks, oral itraconazole 400 mg/d for 10 weeks and 2 00 mg/d as maintenance therapy), the fever declined in 6 days, the size of the enlarged lymphnodes gradually decreased in the CT scans, and the initia l abdominal and back pain vanished.