Candida tropicalis and Penicillium marneffei mixed fungaemia in a patient with Waldenstrom's macroglobulinaemia

A patient with Waldenstrom's macroglobulinaemia who had previously been tre ated with cladribine presented with septic arthritis caused by Escherichia coli. The patient's condition subsequently deteriorated, and he succumbed t o pneumonia and mixed fungaemia due to Candida tropicalis and Penicillium m arneffei. Profound lymphopenia coexisted with fungaemia. This is the first reported case of mixed Penicillium marneffei and Candida fungaemia and peni cilliosis marneffei in a patient with Waldenstrom's macroglobulinaemia. Pen icilliosis marneffei should be considered as a potential complication in pa tients with markedly impaired cell-mediated immunity who have travelled to or resided in endemic areas. Patients who have undergone therapy with purin e nucleoside analogues such as fludarabine and cladribine are also at risk.