Talaromycosis
A 31-year-old man presented to the emergency department with fever, papular skin lesions, and weight loss of 10 kg in the past month. The temperature was 38°C. On examination, he appeared cachectic and had umbilicated papules on his face (Panel A), body, arms, and legs. Laboratory studies showed a hemoglobin level of 8.3 g per deciliter (reference range, 13 to 16), a white-cell count of 9200 per cubic millimeter (reference range, 4000 to 10,000) with 88% neutrophils and 4% lymphocytes, and a platelet count of 80,000 per cubic millimeter (reference range, 150,000 to 400,000). Testing for human immunodeficiency virus (HIV) was positive, with a CD4 T-cell count of 10 cells per cubic millimeter. A blood smear showed numerous yeastlike organisms measuring 2 to 4 μm in diameter that were both intracellular (Panel B) and extracellular. Gram’s staining of blood cultures showed septate hyphae fungus (Panel C) that was identified as Talaromyces marneffei (formerly Penicillium marneffei). T. marneffei is a dimorphic fungus that can cause disseminated infection, most commonly in patients with HIV infection. Patients often present with respiratory symptoms, lymphadenopathy, fever, and anemia. Talaromycosis is endemic in Southeast Asia. Despite treatment with amphotericin B, the patient died 4 days after admission.
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