| Penicillium marneffei is rarely pathogenic in humans. Most previously
reported cases of P. marneffei infection were from Southeast Asia where
patients were usually in an immunocompromised state due to human
immunodeficiency virus (HIV) infection. The majority of the patients reported
in Western countries were immunocompromised by malignancy, especially Hodgkin's
lymphoma. In Taiwan, the first case of P. marneffei infection was reported in
1994 and involved an adult with HIV infection. We report a case of systemic P.
marneffei infection in a child with common variable immunodeficiency (CVID). The
patient, a 4-year, 5-monthold boy, had a 1-year history of oligoarthritis
resembling juvenile rheumatoid arthritis (JRA). He developed a low grade fever
(38℃) and hepatosplenomegaly 1 month before admission to the hospital. Although
cultures of synovial fluid obtained at the time of onset of oligoarthritis did
not grow any organisms, cultures of blood, bone marrow, synovial fluid, and
lymph node biopsy samples taken during this admission were positive for P.
marneffei. Futher immunologic studies revealed a profile characteristic of CVID.
The fungal infection was finally eradicated by combined therapy with
amphotericin B, fluconazole, itraconazole, itraconazole, and regular
immunoglobulin replacement. This case reminds us that JRA or JRA-like arthritis
should be differentiated from septic arthritis caused by rare pathogens in