title: Immune reconstitution inflammatory syndrome from Penicillium marneffei in an HIV-infected child: a case report and review of literature.
abstract: BACKGROUND
  Disseminated Penicillium marneffei infection is one of the most common HIV-related opportunistic infections in Southeast Asia. Immune reconstitution inflammatory syndrome (IRIS) is a complication related to antiretroviral therapy (ART)-induced immune restoration. The aim of this report is to present a case of HIV-infected child who developed an unmasking type of IRIS caused by disseminated P. marneffei infection after ART initiation.
  
  
  METHODS
  A 14-year-old Thai HIV-infected girl presented with high-grade fever, multiple painful ulcerated oral lesions, generalized non-pruritic erythrematous skin papules and nodules with central umbilication, and multiple swollen, warm, and tender joints 8 weeks after ART initiation. At that time, her CD4+ cell count was 7.2% or 39 cells/mm3. On admission, her repeated CD4+ cell count was 11% or 51 cells/mm3 and her plasma HIV-RNA level was < 50 copies/mL. Her skin biopsy showed necrotizing histiocytic granuloma formation with neutrophilic infiltration in the upper and reticular dermis. Tissue sections stained with hematoxylin and eosin (H&E), periodic acid-Schiff (PAS), and Grocott methenamine silver (GMS) stain revealed numerous intracellular and extracellular, round to oval, elongated, thin-walled yeast cells with central septation. The hemoculture, bone marrow culture, and skin culture revealed no growth of fungus or bacteria. Our patient responded well to intravenous amphotericin B followed by oral itraconazole. She fully recovered after 4-month antifungal treatment without evidence of recurrence of disease.
  
  
  CONCLUSIONS
  IRIS from P. marneffei in HIV-infected people is rare. Appropriate recognition and properly treatment is important for a good prognosis.
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, 50200 Chiang Mai, Thailand.
authors.forename: Tavitiya
authors.initials: T
authors.lastname: Sudjaritruk
authors.forename: Thira
authors.initials: T
authors.lastname: Sirisanthana
authors.forename: Virat
authors.initials: V
authors.lastname: Sirisanthana
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001210:Asia, Southeastern; D003881:Dermatomycoses / Q000382:microbiology / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006225:Hand / Q000000981:diagnostic imaging / Q000473:pathology; D006651:Histocytochemistry; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D007866:Leg / Q000000981:diagnostic imaging / Q000473:pathology; D008853:Microscopy; D009181:Mycoses / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D010019:Osteomyelitis / Q000382:microbiology / Q000473:pathology; D010407:Penicillium / Q000302:isolation & purification*; D011859:Radiography
chemical_list: D019380:Anti-HIV Agents