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1、Case DiscussionsDepartmentofClinicalLaboratoryHunanChildren’sHospitalCasePresentationA14-year-oldChinesegirlpresentedataprovincialhospitalwithfever,oralulcers,disseminatedpapularlesionsandmultiplejointpainfor4weeksTwelveweeksbeforethisadmission,shewasdiagnosedasacas
2、eofperinatalHIVinfectionafterpresentingwithdisseminatedherpeszosterinfectionandPneumocystisjiroveciipneumonia(PJP)Atthattime,herCD4+cellcountwas7.2%or39cells/mm3.PlasmaHIV-RNAlevelwasnotobtainedShewasstartedonGPOvirS30®(afixeddrugcombinationofstavudine,lamivudineand
3、nevirapine)andPJPprophylaxiswithtrimethoprim-sulfamethoxazoleEightweeksafterstartingART(antivitroviraltherapy)shedevelopedfever,multiple,oralulcers,disseminatedpapularlesionsovertheface,body,andextremities,andseverepaininmanyjointsThesymptomsdidnotrespondtomanykinds
4、oforalantibioticsandshewasreferredtoHunanchildren’Hospital.PhysicalExaminationFever,multiple,oralulcers,disseminatedpapularlesionsovertheface,body,andextremities,andseverepaininmanyjointsLaboratoryResultsExaminationsCD4+cellcountwas11%or51cells/mm3.PlasmaHIV-RNAleve
5、lwas<50copies/mLChestroentgenogramwasnormalRoentgenogramsofbothwristsandanklesshowedmultipleroundradiolucentdefectsofthebonesNoorganismwasobservedinthebonemarrowaspiratespecimenThehemoculture,bonemarrowculture,andskinculturerevealednoevidenceoffungus.Bloodwasalsosen
6、tformycobacterialculturewithnegativeresultsSerumcryptococcalantigenwasnegative.SkinbiopsySkinbiopsyshowednecrotizinghistiocyticgranulomaformationwithneutrophilicinfiltrationintheupperandreticulardermisTissuesectionsfromskinbiopsystainedwithhematoxylinandeosin(H&E),p
7、eriodicacid-Schiff(PAS),andGrocottmethenaminesilver(GMS)stainrevealednumerousintracellularandextracellular,roundtooval,elongated,thin-walledyeastcellswithcentralseptationPhotomicrographoftheorganismsNumerousintracellularandextracellular,roundtooval,elongated,thin-wa
8、lledyeast-likeorganismsThecharacteristictransverseseptum(arrows)withintheyeastcellisseenWhat wasthedisease?Why?DiscussionPenicilliummarnef
