Triple Trouble: Disseminated Penicilliosis in a Cancer patient with COVID-19

Abstract

Penicilliosis is a fungal infection caused by the fungus Penicillium marneffei or Talaromyces marneffei. Penicillosis is commonly seen in immunocompromised patients such as in HIV(AIDS). Herein, we present a case of penicilliosis in an oral cavity cancer patient who was admitted for the management of SARS-CoV-2 infection at our hospital. A 50-year-old male patient operated on for squamous cell carcinoma of the oral cavity who completed his adjuvant chemoradiation 2 months ago, presented to our hospital with dry cough for more than 3 weeks. His nasopharyngeal swab was positive for the severe acute respiratory distress syndrome (SARS-CoV-2). During his hospital stay for SARS-CoV-2 infection, he was diagnosed with disseminated penicilliosis. The patient was treated with intravenous antifungals caspofungin and voriconazole. However, he succumbed to disseminated fungal sepsis. This case highlights the need to consider penicilliosis as a possible opportunistic pathogen, especially in immunocompromised patients such as cancer.

Keywords

penicilliosis - cancer - oral cavity - SARS-CoV-2 - COVID-19

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Publication History

Article published online:
29 March 2023

• References

• 1 Talaromycosis (formerly Penicilliosis) Fungal Diseases CDC. Accessed October 30, 2021, at: www.cdc.gov
• 2 Sun J, Sun W, Tang Y. et al. Clinical characteristics and risk factors for poor prognosis among HIV patients with Talaromyces marneffei bloodstream infection. BMC Infect Dis 2021; 21 (01) 514
• 3 Zheng J, Gui X, Cao Q. et al. A clinical study of acquired immunodeficiency syndrome associated Penicillium marneffei infection from a non-endemic area in China. PLoS One 2015; 10 (06) e0130376
• 4 Stone A, Park BJ. Penicillium marneffei Infection: Knowledge, Gaps, and Future Directions. Curr Fungal Infect Rep 2011; 5 (04) 193
• 5 Ching-López R, Rodríguez Pavón S. Talaromycosis in a lung cancer patient: a rare case. Cureus 2020; 12 (09) e10615
• 6 Gorai S, Saha M, Madhab V, Mitra S. Talaromycosis (penicilliosis): a rare, opportunistic systemic fungal infection. Indian J Dermatol 2019; 64 (04) 331-333
• 7 Goldman JD, Lye DCB, Hui DS. et al; GS-US-540-5773 Investigators. Remdesivir for 5 or 10 days in patients with severe covid-19. N Engl J Med 2020; 383 (19) 1827-1837
• 8 Horby P, Lim WS, Emberson JR. et al; RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021; 384 (08) 693-704
• 9 Ranjbar K, Moghadami M, Mirahmadizadeh A. et al. Methylprednisolone or dexamethasone, which one is superior corticosteroid in the treatment of hospitalized COVID-19 patients: a triple-blinded randomized controlled trial. BMC Infect Dis 2021; 21 (01) 337
• 10 Pang J, Xu F, Aondio G. et al. Efficacy and tolerability of bevacizumab in patients with severe Covid-19. Nat Commun 2021; 12 (01) 814
• 11 Ramírez I, Hidrón A, Cardona R. Successful treatment of pulmonary invasive fungal infection by Penicillium non-marneffei in lymphoblastic lymphoma: case report and literature review. Clin Case Rep 2018; 6 (06) 1153-1157
• 12 Vanittanakom N, Cooper Jr CR, Fisher MC, Sirisanthana T. Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects. Clin Microbiol Rev 2006; 19 (01) 95-110
• 13 Yadav S, Gupta R, Anuradha S, Makkar AM. A rare case of disseminated penicilliosis – first of its kind from North India. Indian J Pathol Microbiol 2019; Jan-Mar; 62 (01) 156-158
• 14 Huang YT, Hung CC, Liao CH, Sun HY, Chang SC, Chen YC. Detection of circulating galactomannan in serum samples for diagnosis of Penicillium marneffei infection and cryptococcosis among patients infected with human immunodeficiency virus. J Clin Microbiol 2007; 45 (09) 2858-2862
• 15 Li CS, Pan SF. Analysis and causation discussion of 185 severe acute respiratory syndrome dead cases [article in Chinese]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2003; 15 (10) 582-584
• 16 Peng J, Wang Q, Mei H. et al. Fungal co-infection in COVID-19 patients: evidence from a systematic review and meta-analysis. Aging (Albany NY) 2021; 13 (06) 7745-7757
• 17 Singh RB, Devi KR. A comparative study on antifungal susceptibility of Penicillium marneffei (Talaromyces marneffei) and nonmarneffei Penicillium species. J Med Soc 2018; 32: 22-26
• 18 Supparatpinyo K, Schlamm HT. Voriconazole as therapy for systemic Penicillium marneffei infections in AIDS patients. Am J Trop Med Hyg 2007; 77 (02) 350-353
• 19 Lin F, Qiu Y, Zeng W, Liang Y, Zhang J. Talaromyces marneffei infection in a lung cancer patient: a rare case report. BMC Infect Dis 2019; 19 (01) 336
• 20 Yang Z, Zeng W, Qiu Y, Liu G, Zhang J. Nodular sclerosing Hodgkin lymphoma combined with disseminated Talaromyces marneffei infection: a case report. Infect Drug Resist 2021; 14: 5671-5678
• 21 Fedorková L, Vojtech I, He LP, Ondruš D. Multiresistent opportunistic talaromycosis in a patient with ovarian cancer. Klin Onkol 2020; 33 (06) 464-466
• 22 Narayanasamy S, Dat VQ, Thanh NT. et al. A global call for talaromycosis to be recognised as a neglected tropical disease. Lancet Glob Health 2021; 9 (11) e1618-e1622