Imbibed

A 45-year-old man presents with multiple lumps over his face and neck for 3 months. The lumps are small, painless, and non-tender. Close questioning reveals intermittent low-grade fever, a non-productive cough, anorexia, and a loss of 10 kg of weight, all over the last half-year.

His medical and surgical histories are unremarkable, and he is not on any medications. He does not smoke, but drinks around 7 to 10 units of alcohol per week. He has had unprotected sexual intercourse with multiple women over the past two decades. He has never engaged in intravenous (IV) drug abuse.

He unmarried, a Thai citizen, and lives and works in Bangkok. He is currently visiting his brother, who persuaded him to seek medical attention for his complaints.

A complete blood count shows a hemoglobin of 10.5 g/dL (normal: 11-18), WBC of 3,500/mm3 (normal: 4,600-11,000), and platelet count of 180,000/mm3 (normal: 150,000-450,000). Plain x-rays of the chest reveal diffuse reticular infiltrates bilaterally. A renal profile, liver profile, random plasma glucose, and HbA1c are all within normal parameters.

Screening for HIV is positive; follow-up testing with a western blot assay is also positive.

Choisissez les Examens Pertinents
CD4+ count

Faits

CD4+ count: 40/µL (500-1400)
Skin biopsy

Faits

Following staining of the biopsy specimen with silver methenamine, microscopy reveals multiple non-budding yeast cells with a transverse septum.

Samples are sent for culture; these are positive for Talaromyces marneffei.
STI screening

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Negative for chlamydia, gonorrhea, syphilis, hepatitis B, and hepatitis C.
Bronchoalveolar lavage

Faits

Gram stain: negative
Ziehl-Neelsen stain: negative
Silver methenamine stain: non-budding yeast cells with transverse septum

Cultures of the bronchoalveolar lavage specimen are positive for Talaromyces marneffei.

Choisissez les Prises en Charge Pertinentes
Antifungal therapy
Antituberculous therapy
Antiretroviral therapy
Corticosteroid therapy