| Objective In order to improve medical doctors’cognition and standard of diagnosis of penicilliosis marneffei, and decrease misdiagnosis.Methods Analyze and summarize the patients’clinical data, discuss the rare skin presentation,clinical characteristics, histopathologic, diagnosis, differential diagnosis, treatments and outcome of Penicillium marneffei infection according to associated references.Results The patient was 32-year-old Guangxi female, whose main clinical presentations included recurrent multiple skin lesions such as painful papules, nodules and papulopustules on the face and neck and erythema around the body accompanying with fever and bilateral cervical lymphadenopathy. Laboratory data showed increased white blood cell count 24.2 X 109/L, neutrophilic granulocyte percentage 85.2% but negative fungal blood cultures. Histological examination displayed upper dermal dense neutrophilic granulocytes infiltration at early stage, infectious granular inflammation at advance stage and negative fungus. Initial diagnosis was Sweet’s syndrome treated with unsuccessful glucocorticosteroid and antibiotics. Penicilliosis Marneffei was proven by positive fungal culture of skin lesion discharge and biopsy tissue eight months after onset. Skin rashes were dismissed and body temperature decreased after oral anti-fungal drugs. Patient was cured with anti-fungal medication for one more year.Conclusion Suspicious Penicillium marneffei infection should be considered in HIV-negative patient with recurrent and unclear fever, swollen lymph nodes and sweet’s syndrome-like manifestations from epidemic area. Further measures such as repetitive specimen fungal culture from different lesions maybe contribute to get an early diagnosis as possible. |
