Disseminated Penicillium marneffei infection responding to treatment with oral fluconazole

An ill and stunted 17-year-old boy with biopsy and culture proven recurrent disseminated Penicillium marneffei infection and possible immune deficiency (natural killer cell defect) (1) manifested progressive disease despite receiving repeated prolonged courses of intravenous amphotericin B (cumulative dose 5.33 g over seven years) and (2) there were unacceptable treatment complications (venous thrombophlebitis and febrile reactions). Dramatic subjective and objective improvement ensued, when treatment was changed to oral fluconazole (300 mg daily). Thereafter, all of his various lesions (including those in bone, lymph nodes and other soft tissues) regressed, excepting one superior mediastinal mass which enlarged and was shown to be normal thymic tissue. Having received out-patient fluconazole therapy for just over a year, the patient remains active and virtually asymptomatic; there being no evidence of persisting infection.