Penicilliosis in lupus patients presenting with unresolved fever: a report of 2 cases and literature review.
Penicilliosis is a rare occurrence among non human immunodeficiency virus (HIV)   infected patients. We report here two cases of Penicillium marneffei infection in patients   with systemic lupus erythematosus (SLE). Both patients had a recent flare of lupus and were   on immunosuppressive drugs when they presented with prolonged fever without an obvious   foci of infection, unresponsive to broad-spectrum antibiotics. They were leucopaenic upon   admission, with rapid deterioration during the course of the illness. Diagnosis of penicilliosis   via fungal isolation from blood culture was delayed resulting in the late initiation of antifungal   agents. While both patients ultimately recovered, the delay in diagnosis led to a prolonged   hospital stay with increased morbidity. Clinicians should be aware of this uncommon but   emerging fungal pathogen in SLE patients and maintain a high index of suspicion in diagnosing   this potentially fatal but treatable disease.
Division of Nephrology, Department of Medicine, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia. rayybchong@hotmail.com
Y B
YB
Chong
L P
LP
Tan
S
S
Robinson
S K
SK
Lim
K P
KP
Ng
T C
TC
Keng
A
A
Kamarulzaman
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D057210:Delayed Diagnosis; D005260:Female; D005334:Fever / Q000382:microbiology*; D006760:Hospitalization; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000382:microbiology*; D008297:Male; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D010407:Penicillium / Q000302:isolation & purification / Q000472:pathogenicity*; D055815:Young Adult
D000935:Antifungal Agents; D000666:Amphotericin B