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Penicillium marneffei mesenteric lymphadenitis in human immunodeficiency virus-infected children
N Ukarapol1, V Sirisanthana, L Wongsawasdi
1Gastrointestinal Unit, Faculty of Medicine, Chiang Mai University, Thailand.
Unlabelled:
Disseminated P. marneffei infection is one of the common opportunistic infections seen in HIV-infected patients in Southeast Asia. We report 3 cases of HIV-infected children with mesenteric lymphadenitis presented with prolonged fever and abdominal pain. The first two patients were diagnosed as peritonitis and acute appendicitis prior to exploratory laparotomy. Operative findings revealed multiple enlarged mesenteric lymph nodes. Histopathologic findings of mesenteric lymph nodes biopsy were characteristic for P. marneffei infection. Mesenteric lymphadenitis in the last patient was diagnosed by abdominal ultrasound. All three cases had positive blood and bone marrow cultures for P. marneffei. These patients were treated with amphotericin B. Fever declined in 3-6 days. The first two patients survived but the last one subsequently died from underlying hemophilia A (GI bleeding).
Conclusion:
Acute mesenteric lymphadenitis can be one of the unusual manifestations caused by P. marneffei. Southeast Asia is an endemic area for P. marneffei and is severely affected by acquired immunodeficiency syndrome epidemic. Therefore, mesenteric lymphadenitis should be considered in HIV-infected persons who present with prolonged fever and abdominal pain.
Insights
Disseminated Penicillium marneffei infection can cause unusual mesenteric lymphadenitis in children with HIV in Southeast Asia. Early consideration of this opportunistic infection is crucial for timely diagnosis and treatment.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pediatric Infectious Diseases
Background:
- Disseminated Penicillium marneffei infection is a significant opportunistic infection in Human Immunodeficiency Virus (HIV)-infected individuals, particularly in Southeast Asia.
- Acquired Immunodeficiency Syndrome (AIDS) epidemics contribute to a high prevalence of opportunistic infections in endemic regions.
Observation:
- Three cases of HIV-infected children presenting with prolonged fever and abdominal pain were diagnosed with mesenteric lymphadenitis.
- Initial diagnoses included peritonitis and acute appendicitis, necessitating exploratory laparotomy in two patients.
- Histopathology of mesenteric lymph node biopsies confirmed P. marneffei infection, and blood/bone marrow cultures were positive.
Findings:
- Mesenteric lymphadenitis, an unusual manifestation, was identified in HIV-infected children with P. marneffei infection.
- Prompt treatment with amphotericin B led to fever reduction within 3-6 days.
- Two patients survived, while one succumbed due to underlying hemophilia A complications.
Implications:
- Mesenteric lymphadenitis should be considered in the differential diagnosis of HIV-infected patients in Southeast Asia presenting with prolonged fever and abdominal pain.
- This highlights the importance of recognizing atypical presentations of P. marneffei infections in immunocompromised populations.
- Early diagnosis and management are critical for improving outcomes in disseminated P. marneffei infections.