Immune Restoration Syndrome with disseminated Penicillium marneffei and Cytomegalovirus co-infections in an AIDS patient

Abstract

BackgroundPenicillium marneffei is a dimorphic fungus, endemic in South-east Asia. The fungus causes severe disease in immunocompromised patients such as AIDS. However, no case of immune restoration disease of Penicillium marneffei is reported in literature from a non-endemic area.Case PresentationWe report the first case of Penicillium marneffei and Cytomegalovirus infection manifesting as a result of immune restoration one month after initiating HAART. This severely immunocompromised patient had presented with multiple lymphadenopathy, massive hepatosplenomegaly, visual impairment and mild icterus, but no skin lesions. Penicillium marneffei was isolated from lymph node fine-needle aspirates and blood cultures.ConclusionIn order to diagnose such rare cases, the clinicians, histopathologists and microbiologists alike need to maintain a strong index of suspicion for making initial diagnosis as well as for suspecting immune reconstitution syndrome (IRS) with Penicillium marneffei.

Penicillium marneffei infection in a lung transplant recipient

“…Concurrent disseminated P. marneffei and cytomegalovirus disease has been reported in some patients (it was excluded in this case), including 1 case presenting with immune‐restoration disease after starting combination antiretroviral therapy . Papular skin lesions with central umbilication, resembling molluscum contagiosum, are commonly described , but were absent in our patient.…”

Penicillium marneffeipresenting as an immune reconstitution inflammatory syndrome (IRIS) in a patient with advanced HIV

“…In our patient's case, the skin nodules, which developed after ART, were distinct from the (subsequently histologically proven) molluscum and follicular lesions present at initial assessment. In the other two cases, lymphadenopathy and/or hepatosplenomegaly were the presenting signs 13 14…”

Relationship Between the Occurrences of Penicilliosis With Cd4 Level in Hiv Infected Patients and Impact on Certain Haematological Parameters - One Year Retrospective Study

“…Identical finding had been documented in previous studies done in Southeast Asian countries. 14,17,18 In this study, the levels of Erythrocyte Sedimentation Rate (ESR) of the penicilliosis in HIV patients had been on higher side between 50 to 100 mm/1st hour suggesting an increase in inflammatory process associated with infection with Penicilliosis.…”