[en] Penicillium marneffei infection is a rare fungal disease that cause significant disease in immunosuppressed patients. The geographical distribution of this dimorphic fungus is restricted to Asia, Southeast and Far East, where the disease is considered as an indicator of acquired immunodeficiency syndrome (AIDS).
Case report. A 42-year old Congolese woman living in Lubumbashi was admitted at the university hospital of Liège for exploration of a general status impairment. She experienced for three months spiking fever, weight loss, productive cough with bloody expectorations and progressive dyspnoea. She reported also to have non-bloody mild diarrhoea with abdominal pain.
The HIV antibody status was positive with a low CD4 T lymphocytes count (28/µl). Pulmonary infiltrates were visualized on chest radiography and the computed tomography revealed the presence of a severe pneumopathy characterised by bilateral micronodular lesions. Mediastinal polyadenopathies associated with hepato- and splenomegaly were also highlighted.
Bronchoscopy was performed and bronchial aspirations revealed the presence of numerous leucocytes with the presence of intracellular Gram positive organisms suggestive of yeasts. Ziehl, Giemsa and Gomori-Grocott staining were also performed. Ziehl staining was negative. The morphological aspect given by Giemsa staining excluded infection and the PCR specific for T. gondii B1 gene was negative. However, Gomori-Grocott staining revealed the presence of intracellular oval, elongated, sausage-shaped cells with a single transverse septum (3 to 5 µm). Penicillium marneffei was isolated from blood culture and respiratory samples.
Intraveinous amphotericin B treatment was administrated during 15 days followed by itraconazole oral administration (200 mg/j). The antimycotic treatment improved the patient condition and despite other clinical troubles she was prematurely discharged because of financial problems.
Conclusion. Opportunistic agents involved in HIV-infected patients differ in Africa and Asia and it is important to be able to make a rapid diagnosis with the aid of an experienced laboratory.
