An abdominal mass owing to Penicillium marneffei in an HIV-infected 7-year-old boy: case report N. OTHMAN, C. W. YIP, H. I. INTAN, Z. ZAINUDDIN* & F. AMRAN { Paediatric Unit, Department of Growth & Development, Faculty of Medicine & Health Sciences, University Putra Malaysia, Malaysia, *Institute of Paediatrics, Hospital Kuala Lumpur, and { Institute for Medical Research, Kuala Lumpur, Malaysia (Accepted April 2006) Abstract A 7-year-old boy, referred with lymphoma, presented with prolonged fever and intra-abdominal lymphadenopathy demonstrated on computed tomography (CT) of the abdomen. Blood culture isolated Penicillium marneffei. The patient was subsequently proven serologically to be positive for human immunodeficiency virus (HIV). Treatment with amphotericin B followed by itraconazole was successful. A high level of clinical suspicion and awareness is necessary for early diagnosis of penicilliosis, especially in an era of an increasing prevalence of HIV in this region. Introduction Penicilliosis is a systemic fungal infection caused by Penicillium marneffei, a thermal dimorphic pathogenic Penicillium sp. It was first isolated in 1956 in bamboo rats (Rhizomys sinensis) in Vietnam and, later, in other rodents. The organism specifically infects patients with HIV infection who live in or visit Southeast Asia where the fungus is endemic. 1 The organism initially invades the reticulo-endothelial system and, in immunocompromised individuals, cuta- neous and systemic dissemination may follow. We describe an HIV-infected boy with systemic penicilliosis. Case Report A 7-year-old Malay boy presented with a 3-week history of intermittent, high-grade fever, abdominal pain and loss of appetite and weight. He was seen at a private hospital where a CT of the abdomen showed grossly enlarged mesenteric and para-aortic lymph nodes (Fig. 1). A presumptive diagnosis of lymphoma was made and he was referred to Hospital Kuala Lumpur. There was no history of cough, haemop- tysis, bleeding tendencies or change of bowel habit. His father considered that his son was normal, apart from having had more fre- quent upper respiratory infections than his siblings since 4 yrs of age. There was no history of contact with tuberculosis and no known illnesses among his family members. His birth was normal, his birthweight was 2.6 kg and his immunisation was complete. On examination, his weight was 19 kg (10th centile), height 119 cm (between the 25th and 50th centile) and weight- for-height ,5th centile. His temperature Reprint requests to: Assoc. Prof. Dr Norlijah Othman, Paediatric Unit, Department of Human Growth and Development, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Jln Masjid 50586, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia. Fax: z60 3 2050 1074; e-mail: nor@medic.upm. edu.my Annals of Tropical Paediatrics (2006) 26, 259–262 # 2006 The Liverpool School of Tropical Medicine DOI: 10.1179/146532806X120381