Clinical presentation

Disseminated P.  marneffei infection in HIV presents as fever, anaemia, weight loss, lymphadenopathy, hepatosplenomegaly, respiratory signs and cutaneous lesions. Cutaneous lesions are of particular importance, appearing in 75% of patients who have penicillinosis, and are specific for the disease. The typical cutaneous lesions are umbilicated papules with central necrotic core. Other morphologies include: ecthyma-like lesions, folliculitis, subcutaneous nodules and morbilliform eruptions.[93] The distribution is on the face and neck and less commonly on the limbs and torso. The differential diagnosis of these lesions includes molluscum contagiosum, Histoplasma and Cryptococcus.[94] ) Patients with severe or persistent dyspnoea, ascites, and increased lactate dehydrogenase (LDH) blood levels are considered at high risk to have a fatal outcome.[95][96] Cutaneous ulcerations due to P. marneffei in the context of ART have been anecdotally reported, with few cases reported as IRIS phenomenon.[97][98]