Abstract
BackgroundInfection with Penicillium marneffei is a common opportunistic infection in Southeast Asia where it is endemic. We report a case of Penicillium marneffei infection with fatal outcome in a Togolese woman infected with Human Immunodeficiency Virus (HIV).Case presentationA 45-years-old patient, infected with Human Immunodeficiency Virus had consulted for ongoing febrile pneumonia since two weeks. Clinical examination revealed fever of 38.5°C, dyspnea, pulmonary syndrome condensation and papulo-nodular of “molluscum contagiosum” like lesions located on the face, arms, neck and trunk. Sputum smear was negative for tuberculosis. The chest radiograph showed reticulonodular opacities in the right upper and middle lobes and two caves in the right hilar region. The CD4 count was 6 cells/mm3 after a year of antiretroviral treatment (Zidovudine-Lamivudine-Efavirenz). She was treated as smear negative pulmonary tuberculosis after a lack of gentamicin and amoxicillin plus clavulanic acid response. Culture of skin samples and sputum had revealed the presence of P. marneffei. A treatment with ketoconazole 600 mg per day was initiated. After two weeks of treatment, there was a decrease in the size and number of papules and nodules, without any new lesions. We noted disappearance of cough and fever. The chest X-ray showed a decrease of pulmonary lesions. There was no reactivation of P. marneffei infection but the patient died from AIDS after two years of follow up.ConclusionWe report a case of P. marneffei infection in a HIV-infected patient in a non-endemic country. Clinicians should think of P. marneffei infection in all HIV-infected patients with “molluscum contagiosum” like lesions.
Highlights
Infection with Penicillium marneffei is a common opportunistic infection in Southeast Asia where it is endemic
We report a case of P. marneffei infection in a Human Immunodeficiency Virus (HIV)-infected patient in a non-endemic country
Clinicians should think of P. marneffei infection in all HIV-infected patients with “molluscum contagiosum” like lesions
Summary
Infection with P. marneffei is an opportunistic infection occurring in immuno compromised patients [1]. Case presentation A 45-year-old woman had consulted on 7th July 2008 in the Department of Infectious Diseases and Pneumology of the teaching hospital “Centre Hospitalier Universitaire” (CHU) Sylvanus Olympio in Lomé for ongoing fever, cough, dyspnea, since two weeks before admission. She was known to be HIV positive and was taking antiretroviral treatment (Zidovudine-Lamivudine-Efavirenz) associated with cotrimoxazole since July 2007. The patient was treated as bacterial pneumonia by the combination of amoxicillin-clavulanic acid and gentamicin for ten days without success, as smear negative pulmonary tuberculosis with two months combination of (rifampicin + isoniazid + pyrazinamide + ethambutol).
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