Oral penicilliosis in a patient with human immunodeficiency virus in northern Thailand

A 25‐year‐old Thai woman with human immunodeficiency virus (HIV) infection diagnosed by serology 4 months previously presented to the outpatient clinic with a chief complaint of a sore throat. Three months prior to presentation, she was diagnosed with oral and vaginal candidiasis and bronchitis. The patient was afebrile and other vital signs were normal. Examination of the oral cavity showed patchy erythema and leukoplakia on the buccal mucosa, suggestive of candidiasis. In addition, there were multiple, shiny, translucent papules, 2–4 mm in diameter, especially prominent on the upper palate, suggestive of penicilliosis ( Fig. 1). Indeed, a Wright‐stained scraping from a papule revealed numerous inflammatory cells, many containing abundant yeast‐like organisms undergoing binary fission characteristic of penicilliosis ( Fig. 2). A slant agar fungal culture of material from an upper palate papule grew Penicillium marneffei , consisting of white, gritty hyphae with underlying deep red coloring as depicted in Fig. 3, as well as Candida albicans . The oral lesions resolved after 2 weeks of treatment with ketoconazole 200 mg twice daily. 1Oral cavity with shiny, flesh‐colored papules on the upper palate. Arrow shows area from where material for Wright's stain and culture was obtained2Smear of papule material from hard palate showing a cluster of intracellular yeast forms (arrow), many undergoing binary fission, consistent with P. marneffei (Wright's stain, × 1000)3Representative slant agar culture of P. marneffei depicting white gritty colonies with underlying red coloring