Candida tropicalis and Penicillium marneffei mixed fungaemia in a patient with Waldenström's macroglobulinaemia

A patient with Waldenström's macroglobulinaemia who had previously been treated with cladribine presented with septic arthritis caused by Escherichia coli. The patient's condition subsequently deteriorated, and he succumbed to pneumonia and mixed fungaemia due to Candida tropicalis and Penicillium marneffei. Profound lymphopenia coexisted with fungaemia. This is the first reported case of mixed Penicillium marneffei and Candida fungaemia and penicilliosis marneffei in a patient with Waldenström's macroglobulinaemia. Penicilliosis marneffei should be considered as a potential complication in patients with markedly impaired cell-mediated immunity who have travelled to or resided in endemic areas. Patients who have undergone therapy with purine nucleoside analogues such as fludarabine and cladribine are also at risk.