Case report

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

Swati Gupta¹ , Purva Mathur¹ , Dipesh Maskey² , Naveet Wig² and Sarman Singh¹

¹  Division of Clinical Microbiology, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi 110029, India

²  Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi 110029, India

author email corresponding author email

AIDS Research and Therapy 2007, 4:21doi:10.1186/1742-6405-4-21

Published:	8 October 2007

Abstract

Background

Penicillium 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 Presentation

We 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.

Conclusion

In 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.