Intestinal invasion and disseminated disease associated with Penicillium chrysogenum.
BACKGROUND
Penicillium sp., other than P. marneffei, is an unusual cause of invasive disease. These organisms are often identified in immunosuppressed patients, either due to human immunodeficiency virus or from immunosuppressant medications post-transplantation. They are a rarely identified cause of infection in immunocompetent hosts.


METHODS
A 51 year old African-American female presented with an acute abdomen and underwent an exploratory laparotomy which revealed an incarcerated peristomal hernia. Her postoperative course was complicated by severe sepsis syndrome with respiratory failure, hypotension, leukocytosis, and DIC. On postoperative day 9 she was found to have an anastamotic breakdown. Pathology from the second surgery showed transmural ischemic necrosis with angioinvasion of a fungal organism. Fungal blood cultures were positive for Penicillium chrysogenum and the patient completed a 6 week course of amphotericin B lipid complex, followed by an extended course oral intraconazole. She was discharged to a nursing home without evidence of recurrent infection.


CONCLUSIONS
Penicillium chrysogenum is a rare cause of infection in immunocompetent patients. Diagnosis can be difficult, but Penicillium sp. grows rapidly on routine fungal cultures. Prognosis remains very poor, but aggressive treatment is essential, including surgical debridement and the removal of foci of infection along with the use of amphotericin B. The clinical utility of newer antifungal agents remains to be determined.
Barcus
Adrian L
AL
Department of Medicine, Wright State University School of Medicine, Dayton, Ohio, USA. adrian-barcus@woh.rr.com
Burdette
Steven D
SD
Herchline
Thomas E
TE
D000006:Abdomen, Acute / Q000382:microbiology*; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000188:drug therapy / Q000382:microbiology*; D007422:Intestines / Q000382:microbiology*; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000382:microbiology*; D010408:Penicillium chrysogenum / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity*; D016896:Treatment Outcome
D000935:Antifungal Agents; D000666:Amphotericin B