‘O.I Spy’: Disseminated Talaromyces marneffei infection in an immunocompromised host

Abstract

A 28-year-old Thai male was referred from Sydney international airport with acute shortness of breath requiring admission to the intensive care unit at a quaternary referral centre. Clinical examination revealed extensive lymphadenopathy, hepatomegaly and an umbilicated rash over his forehead, neck, arms and legs. Laboratory testing demonstrated deranged liver function, acute kidney injury, thrombocytopaenia and an elevated C-reactive protein. Blood cultures after 24 h incubation were positive for fungal elements. Yeast forms were visible within neutrophils on blood films, and a skin biopsy showed numerous yeast like organisms. A mould grew on solid media. This dimorphic fungus was identified as Talaromyces marneffei using molecular methods and the patient completed treatment with antifungals. HIV serology was positive with a CD4 count of 10 cells/μL, and multiple associated infections were identified and treated.