Ulceronecrotic penicillosis

Area of Science:

• Mycology
• Infectious Diseases
• Immunology

Background:

• Penicillium marneffei is an endemic dimorphic fungus causing systemic infections, particularly in immunocompromised individuals.
• Human immunodeficiency virus (HIV)-positive patients on highly active antiretroviral therapy (HAART) remain susceptible to opportunistic infections like penicilliosis.
• Immune reconstitution inflammatory syndrome (IRIS) can complicate HAART initiation or changes, potentially unmasking or exacerbating opportunistic infections.

Purpose of the Study:

• To report a case of Penicillium marneffei infection in an HIV-positive patient presenting with unusual initial symptoms and subsequent dissemination.
• To highlight the clinical course, diagnostic findings, and treatment response in a patient with recurrent penicilliosis.
• To discuss the potential role of immunosuppression and IRIS in the pathogenesis of disseminated penicilliosis.

Main Methods:

• Case report of a 40-year-old male HIV-positive patient.
• Diagnosis confirmed by fine needle aspiration cytology (FNAC) and skin biopsy showing yeast forms of Penicillium marneffei.
• Treatment monitored with itraconazole at varying dosages (200 mg/day and 400 mg/day).

Main Results:

• Initial bilateral cervical lymphadenopathy resolved with 9 months of itraconazole (200 mg/day).
• Seven years later, generalized papulonodules and ulceronecrotic skin lesions appeared following a change in HAART.
• Significant improvement in skin lesions was observed within 2 weeks of increasing itraconazole to 400 mg/day, with continued treatment at 200 mg/day.

Conclusions:

• Penicilliosis can present initially with cervical adenopathy and later develop severe skin manifestations, suggesting a link to profound immunosuppression and potential IRIS.
• Itraconazole is an effective antifungal agent for treating Penicillium marneffei infections in HIV-positive individuals.
• Close monitoring and appropriate management of opportunistic infections are crucial in HIV patients, especially during periods of changing immunosuppression or HAART regimen.