Abstract
BackgroundPenicillium sp., other than P. marneffei, is an unusual cause of invasive disease. These organisms are often identified in immunosuppressed patients, either due to human immunodeficiency virus or from immunosuppressant medications post-transplantation. They are a rarely identified cause of infection in immunocompetent hosts.Case presentationA 51 year old African-American female presented with an acute abdomen and underwent an exploratory laparotomy which revealed an incarcerated peristomal hernia. Her postoperative course was complicated by severe sepsis syndrome with respiratory failure, hypotension, leukocytosis, and DIC. On postoperative day 9 she was found to have an anastamotic breakdown. Pathology from the second surgery showed transmural ischemic necrosis with angioinvasion of a fungal organism. Fungal blood cultures were positive for Penicillium chrysogenum and the patient completed a 6 week course of amphotericin B lipid complex, followed by an extended course oral intraconazole. She was discharged to a nursing home without evidence of recurrent infection.DiscussionPenicillium chrysogenum is a rare cause of infection in immunocompetent patients. Diagnosis can be difficult, but Penicillium sp. grows rapidly on routine fungal cultures. Prognosis remains very poor, but aggressive treatment is essential, including surgical debridement and the removal of foci of infection along with the use of amphotericin B. The clinical utility of newer antifungal agents remains to be determined.
Highlights
Penicillium sp., other than P. marneffei, is an unusual cause of invasive disease
Penicillium chrysogenum is a rare cause of infection in immunocompetent patients
Fungal blood cultures were obtained and the patient was started on amphotericin B lipid complex
Summary
P. marneffei is a common cause of infection in the HIV population in endemic areas of Southeast Asia. In vitro data suggests that newer agents, such as Echinocandins (such as caspofungin or micafungin), triazoles (such as voriconazole) and terbinafine have activity, though clinical data is still lacking [11,12] At this time the best evidence appears to support amphotericin B in conjunction with strategies aimed at removing the focus of infection, such as removal of lines, replacement of infected valves, or surgical debridement of affected tissue. There is no standard duration of therapy (reports range from 2–12 weeks of treatment) [2] and each case needs to be individualized to determine appropriate length of antifungal administration. Even with these interventions, the prognosis for Penicillium infections remains poor. Sensitivity testing provided by Fungus Testing Laboratory, San Antonia, Texas
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