Multiple Nodular Pulmonary Lesions in a Human Immunodeficiency Virus-Infected Patient: An Unusual Manifestation of Invasive Penicillium Marneffei Infection

馬氏青黴菌具有二形性，即是於37℃時呈酵母細胞狀，在25℃時見則呈黴菌狀。馬氏青黴菌感染具有地域性，好發於東南亞、中國南及西南方、香港、台灣、泰國、越南、菲律賓等一帶。而在某些國家，馬氏青黴菌病更是愛滋病人中常見的感染。例如在秦國北部，馬氏青黴菌病僅次於結核病及隱球菌感染，成為第三種最常見的伺機性感染。大部份馬氏青黴菌感染在胸部X光片上的表現大多呈現混合肺泡和間質性浸潤。我們提出這個病例：一位60歲男性愛滋病患，一開始胸部X光片以多發性結節表現，懷疑是結核菌感染、隱球菌感染、卡波西氏肉瘤、或轉移性癌症。後來血液培養、經電腦斷層指引抽取組織培養、以及病理報告均是馬氏青黴菌感染。我們提出這個病例說是讓臨床醫師在看到愛滋病患胸部X光片以多發性結節表現時，能把馬氏青黴菌感染列入其中之一鑑別診斷，亦能儘早給予治療。

關鍵字

馬氏青黴菌；後天免疫缺乏症候群；愛滋病

並列摘要

Penicillium marneffel is endemic in southeastern Asian countries. In northern Thailand, it is the third most common opportunistic infection following tuberculosis and cryptococcosis in human immunodeficiency virus (HIV)-infected patients with acquired immunodeficiency syndrome (AIDS). The chest roentgenograms in such cases usually show mixed alveolar and interstitial infiltrates. We report a 60-year-old male HIV-infected patient with P. marneffei infection whose chest film initially presented with multiple nodular lesions. Generally, HIV patients with multiple pulmonary nodules should be considered as having pulmonary tuberculosis, Pneumocystis carinii pneumonia (PCP), cryptococcal pneumonia, Kaposi's sarcoma, or metastatic carcinoma. This case presented an unusual manifestation of invasive P. marneffei infection with multiple nodular pulmonary lesions. Thus, when HIV-infected patients present with multiple pulmonary nodules, P. marneffei infection should be considered.

並列關鍵字

Penicillium marneffei ； acquired immunodeficiency syndrome ； human immunodeficiency virus

國際替代計量

Multiple Nodular Pulmonary Lesions in a Human Immunodeficiency Virus-Infected Patient: An Unusual Manifestation of Invasive Penicillium Marneffei Infection

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