1. ¹Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
2. ²Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
3. ³Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
4. ⁴Division of Pathology, Hospital for Sick Children and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada

Correspondence: Benjaporn Chaiwun, M.D., Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; e-mail: bchaiwun@mail.med.cmu.ac.th; fax: 66-53-217144.

Accepted 22 May 2002.

Abstract

Penicillium marneffei is an opportunistic fungal infection that usually causes disseminated disease, mainly in immunocompromised individuals, especially those with HIV infection. Untreated cases are usually fatal. Diagnosis is traditionally made by biopsy and/or culture; successful diagnosis by fine needle aspiration (FNA) has only been reported once. We present eight cases of HIV-infected patients with lymphadenopathy caused by P. marneffei infection, in which the diagnosis was made by FNA. In all cases, intracellular and extracellular yeast forms were visualized, and the characteristic cross-septation of P. marneffei was highlighted by GMS staining. All diagnoses were confirmed by culture. Anti-fungal treatment for P. marneffei was initiated, resulting in marked clinical improvement. We conclude that a diagnosis of lymphadenopathy caused by P. marneffei can reliably be made by FNA. The diagnosis is more rapid than biopsy or culture, allowing rapid institution of therapy, particularly important in immunocompromised patients. In all our cases, not only were lymphoma and other causes of lymphadenopathy ruled out, but also the necessity for an open surgical biopsy was obviated. This can be especially beneficial to patients (e.g., three in our study) in which lymphadenopathy is confined to deep intra-abdominal nodes.