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Background  Infection with  Penicillium marneffei  is a common opportunistic infection in Southeast Asia where it is endemic. We report a case of  Penicillium marneffei  infection with fatal outcome in a Togolese woman infected with Human Immunodeficiency Virus (HIV).    Case presentation  A 45-years-old patient, infected with Human Immunodeficiency Virus had consulted for ongoing febrile pneumonia since two weeks. Clinical examination revealed fever of 38.5°C, dyspnea, pulmonary syndrome condensation and papulo-nodular of “molluscum contagiosum” like lesions located on the face, arms, neck and trunk. Sputum smear was negative for tuberculosis. The chest radiograph showed reticulonodular opacities in the right upper and middle lobes and two caves in the right hilar region. The CD4 count was 6 cells/mm 3  after a year of antiretroviral treatment (Zidovudine-Lamivudine-Efavirenz). She was treated as smear negative pulmonary tuberculosis after a lack of gentamicin and amoxicillin plus clavulanic acid response. Culture of skin samples and sputum had revealed the presence of  P. marneffei . A treatment with ketoconazole 600 mg per day was initiated. After two weeks of treatment, there was a decrease in the size and number of papules and nodules, without any new lesions. We noted disappearance of cough and fever. The chest X-ray showed a decrease of pulmonary lesions. There was no reactivation of  P. marneffei  infection but the patient died from AIDS after two years of follow up.    Conclusion  We report a case of  P. marneffei  infection in a HIV-infected patient in a non-endemic country. Clinicians should think of  P. marneffei  infection in all HIV-infected patients with “molluscum contagiosum” like lesions.

First observation in a non-endemic country (Togo) of Penicillium marneffei infection in a human immunodeficiency virus-infected patient: a case report