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Penicillium marneffei fungaemia in an allogeneic bone marrow transplant recipient

Bone Marrow Transplantation volume 35, pages 831–833 (2005)Cite this article

Penicillium marneffei is the most important thermal dimorphic fungus causing respiratory, skin and systemic mycosis in Southeast Asia.1, 2, 3 About 8% of AIDS patients in Hong Kong are infected with P. marneffei. Clinically, penicilliosis manifests as a systemic febrile illness, which results from intracellular infection of the reticuloendothelial cells by the yeast phase of the fungus. Besides HIV-positive patients, P. marneffei infections have been reported in other immunocompromised patients, such as renal transplant recipients, patients with systemic lupus erythematosus and patients who are receiving corticosteroid therapy.4, 5 Here, we describe the first case of P. marneffei infection in a bone marrow transplant recipient.

A 57-year-old Chinese man was admitted to hospital in March 2004 because of progressive shortness of breath for 1 month. He was diagnosed with IgA myeloma (stage IIIA) in July 2000 and received an allogeneic peripheral blood stem cell (HLA-matched) transplant in December 2000, using fludarabine and total body irradiation as conditioning. Ciprofloxacin, acyclovir and fluconazole were given as the antimicrobial prophylaxis.6 Engraftment occurred on day 18. However, the transplant was complicated by acute graft-versus-host disease (onset day 34), Clostridium difficile colitis (day 36), cytomegalovirus colitis (day 38), chronic graft-versus-host disease (onset day 163) and herpes zoster (day 266). At 1 year after his transplant, he developed bronchiolitis obliterans organizing pneumonia (BOOP) confirmed by open-lung biopsy and was commenced on oral prednisolone (40 mg daily), which was gradually tailed off and stopped 9 months later. At 2 months before this admission, he was restarted on oral prednisolone (30 mg daily) because of worsening of BOOP. His condition was further complicated by corticosteroid-induced diabetes mellitus requiring oral hypoglycaemic agents. On admission, he was afebrile. Chest radiograph revealed bilateral diffuse ground glass opacities. Culture of the bronchoalveolar lavage fluid only resulted in only a scanty growth of Candida albicans. The dose of prednisolone was increased to 40 mg twice daily to control the BOOP.

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Acknowledgements

This work was supported by the AIDS Trust Fund (MSS 083), Research Grant Council Grant (HKU 7363/03M) and University Development Fund, Hong Kong.

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  1. Department of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong

    P C Y Woo, S K P Lau, C C Y Lau, K T K Chong, W T Hui, S S Y Wong & K Y Yuen

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Woo, P., Lau, S., Lau, C. et al. Penicillium marneffei fungaemia in an allogeneic bone marrow transplant recipient. Bone Marrow Transplant 35, 831–833 (2005). https://doi.org/10.1038/sj.bmt.1704895

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