A Case of Pulmonary Tuberculosis Followed by Penicilliosis Marneffei without HIV Infection

Background: Penicilliosis marneffei （ P. Marneffei ） is an important opportunistic pathogen found in in human immunodeficiency virus（HIV）-positive individuals. But there are few reports that tuberculosis （TB） patients are followed by P. Marneffei without HIV Infection. Case presentation: A female patient, aged 45, admitted to a local hospital in 2008 due to fever and cough. The patient received transbronchial needle aspiration under bronchoscopy, and the smear indicated positive for acid-fast bacilli. Therefore, the patient began to receive 2HRZE/7HR regimen on May 23, 2009 untill to February 2010. The patient returned to normal.On April 25,2014, the patient had fever again and received HRZEMfx regimen. Two weeks late, the patient still had fever. He received lymph node biopsy and was confirmed as P. Marneffei by pathological examination, tissue culture and transmission electron microscopy analysis. Multiple HIV tests were all negative.Patient’s fever subsided after intravenous infusion of voriconazole for 2 weeks, and the patient recovered after oral administration of the same dose of voriconazole tablets for 6 months. Conclusions: : After the regular anti-TB treatment and stability, TB patients again have the clinical manifestations such as fever, swollen lymph nodes, etc. We cannot simply consider TB recurrence or resistance. Clinicians need to consider the possibility of infection with other pathogens.