Penicillium Marneffei Mesenteric Lymphadenitis in Human Immunodeficiency Virus -infected Children
NUTHAPONG UKARAPOL, M.D.*, VIRAT SIRISANTHANA, M.D.**, LUMDUAN WONGSAWASDI, M.D.*
Affiliation : * Gastrointestinal Unit, ** Infectious Disease Unit, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Abstract
Disseminated P. marneffei infection is one of the common opportumsttc infections
seen in HIV-infected patients in Southeast Asia. We report 3 cases of HIV-infected children
with mesenteric lymphadenitis presented with prolonged fever and abdominal pain. The first
two patients were diagnosed as peritonitis and acute appendicitis prior to exploratory laparotomy.
Operative findings revealed multiple enlarged mesenteric lymph nodes. Histopathologic findings
of mesenteric lymph nodes biopsy were characteristic for P. marneffei infection. Mesenteric lym-
phadenitis in the last patient was diagnosed by abdominal ultrasound. All three cases had positive
blood and bone marrow cultures for P. marneffei. These patients were treated with amphotericin
B. Fever declined in 3-6 days. The first two patients survived but the last one subsequently
died from underlying hemophilia A (GI bleeding).
Conclusion: Acute mesenteric lymphadenitis can be one of the unusual manifesta-
tions caused by P. marneffei. Southeast Asia is an endemic area for P. marneffei and is severely
affected by acquired immunodeficiency syndrome epidemic. Therefore, mesenteric lympha-
denitis should be considered in HIV -infected persons who present with prolonged fever and
abdominal pain.
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