BMJ Case Reports 2013; doi:10.1136/bcr-2012-007555

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

  1. Peter Moss1
  1. 1Department of Infection and Tropical Medicine, Hull and East Yorkshire NHS Trust, Cottingham, East Riding of Yorkshire, UK
  2. 2Department of Medicine, North Lincolnshire and Goole Hospitals, Grimsby, North East Lincolnshire, UK
  1. Correspondence to Dr Charlotte Hall, charlotteamyhall{at}


A 62-year-old British man with advanced HIV was established on antiretroviral therapy and treatment for disseminated Mycobacterium avium complex and Cytomegalovirus infections. One month later he re-presented with epigastric pain, an epigastric mass and skin lesions. Abdominal imaging revealed large volume lymphadenopathy, which was not present on previous imaging. Blood cultures yielded Penicillium marneffei, a dimorphic fungus endemic to South-east Asia. The patient had spent several years travelling in Thailand prior to the diagnosis of HIV. Penicilliosis is a common AIDS-defining illness in endemic areas, but remains rare in Europe. In this case, it presented in the context of a rapidly decreasing viral load as an immune reconstitution inflammatory syndrome. The challenges of management in the context of multiple comorbidities and polypharmacy are discussed.

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