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Abstract   Rationale:  This report describes a rare case in Wenzhou city of Zhejiang province that a non-HIV infected male recovering from fungemia caused by  Penicillium marneffei  ( P. marneffei ). Interestingly, it's very easy to misdiagnose with aspergillosis, a fungal disease prevalent in Wenzhou, during the whole procedure.    Patient concerns:  An 80-year-old Chinese male subject with pre-existing chronic obstructive pulmonary disease (COPD) presented with symptoms of chest tightness and high fever for a month.    Diagnoses:  Fungal culture from the blood isolated  P marneffei . Naturally, the patient was diagnosed with  P marneffei  fungemia. However, he was proven serologically to be negative for human immunodeficiency virus (HIV).    Interventions:  The patient was treated with voriconazole at 200mg/dL every 12 hours via intravenous administration.    Outcomes:  The fever returned to normal and chest tightness disappeared gradually after a week of voriconazole treatment.    Lessons:  A high level of clinical suspicion and awareness is necessary for early diagnosis of  P marneffei  fungemia, especially in elder patients with underlying diseases.

Fungemia caused by Penicillium marneffei in an immunocompetent patient with COPD