Clinical presentation | HIV Management Guidelines

Disseminated P. marneﬀei infection in HIV presents as fever, anaemia, weight loss, lymphadenopathy, hepatosplenomegaly, respiratory signs and cutaneous lesions. Cutaneous lesions are of particular importance, appearing in 75% of patients who have penicillinosis, and are speciﬁc for the disease. The typical cutaneous lesions are umbilicated papules with central necrotic core. Other morphologies include: ecthyma-like lesions, folliculitis, subcutaneous nodules and morbilliform eruptions.^[93] The distribution is on the face and neck and less commonly on the limbs and torso. The diﬀerential diagnosis of these lesions includes molluscum contagiosum, Histoplasma and Cryptococcus.^[94] ) Patients with severe or persistent dyspnoea, ascites, and increased lactate dehydrogenase (LDH) blood levels are considered at high risk to have a fatal outcome.^[95], ^[96] Cutaneous ulcerations due to P. marneﬀei in the context of ART have been anecdotally reported, with few cases reported as IRIS phenomenon.^[97], ^[98]