title: Disseminated Penicillium marneffei mimicking paradoxical response and relapse in a non-HIV patient with pulmonary tuberculosis.
abstract: Clinical deterioration during the treatment of tuberculosis remains a diagnostic challenge. We describe the case of a 46-year-old man with a history of oral cancer status after a radical operation who had pulmonary tuberculosis with pleura and neck lymph node involvement. The clinical condition improved after antituberculosis therapy. However, the patient suffered from low-grade fever, progressive dyspnea, and cough after 7 weeks of the therapy. The findings of chest plain films were relapse and progression of left lung haziness. The deterioration was caused by disseminated Penicillium marneffei infection. Disseminated P. marneffei in a non-HIV patient with tuberculosis is rarely seen, and the manifestations are similar to a paradoxical response and relapse of pulmonary tuberculosis, thereby making it difficult to establish a diagnosis.
authors.affiliation: Division of Thoracic Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan, ROC.
authors.forename: Ping-Huai
authors.initials: PH
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC. Electronic address: hcwang@ntumc.org.
authors.forename: Hao-Chien
authors.initials: HC
authors.lastname: Wang
authors.affiliation: Division of Infectious Disease, Far Eastern Memorial Hospital, Taipei, Taiwan, ROC.
authors.forename: Chun-Hsing
authors.initials: CH
authors.lastname: Liao
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000209:etiology*; D010407:Penicillium; D012008:Recurrence; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy
chemical_list: D000666:Amphotericin B
keywords: Penicillium marneffei; human immunodeficiency virus; tuberculosis