Oral penicilliosis in a patient with human immunodeficiency virus in northern Thailand

A 25-year-old Thai woman with human immunodeficiency virus (HIV) infection diagnosed by serology 4 months previously presented to the outpatient clini c with a chief complaint of a sore throat. Three months prior to presentati on, she was diagnosed with oral and vaginal candidiasis and bronchitis. The patient was afebrile and other vital signs were normal. Examination of the oral cavity showed patchy erythema and leukoplakia on the buccal mucosa, s uggestive of candidiasis. In addition, there were multiple, shiny, transluc ent papules, 2-4 mm in diameter, especially prominent on the upper palate, suggestive of penicilliosis (Fig. 1). Indeed, a Wright-stained scraping fro m a papule revealed numerous inflammatory cells, many containing abundant y east-like organisms undergoing binary fission characteristic of penicillios is (Fig. 2). A slant agar fungal culture of material from an upper palate p apule grew Penicillium marneffei, consisting of white, gritty hyphae with u nderlying deep red coloring as depicted in Fig. 3, as well as Candida albic ans. The oral lesions resolved after 2 weeks of treatment with ketoconazole 200 mg twice daily.