(BMJ)—A 31-yo man w/ HIV living in northern Taiwan presented w/ fever x3 days, skin lesions and nausea x2wk, and wt loss of 9 kg over 10mo. Exam: febrile; diffuse nodular, papular, and umbilicated lesions on face and arms; hepatosplenomegaly; generalized lymphadenopathy. Labs: CD4 count 0.7 x 106, pancytopenia, mildly raised liver enzymes. What is the dx?
Molluscum contagiosum
Kaposi sarcoma
Penicilliosis
Atypical mycobacteria
Bacillary angiomatosis
You are correct. Penicilliosis, an invasive infection due to P marneffei that occurs in immunosuppressed pts in SE Asia, was diagnosed based on systemic sx and geographical exposure, and later confirmed by cx. Characteristic molluscum contagiosum-like papular lesions w/ central umbilication are highly suggestive of disseminated P marneffei in an HIV-infected pt in an endemic area. Preferred tx is IV amphotericin B followed by PO itraconazole. This pt improved 5 days after starting fluconazole, but died 6wk later due to sepsis from superinfection of the lesions w/ salmonella.

BMJ 2014;349:g6110