Talaromycosis clinically and histopathologically mimicking histoplasmosis in an immunocompromised patient

Talaromycosis is caused by the dimorphic fungus Talaromyces marneffei (formerly Penicillium marneffei) endemic in South and Southeast Asia. Its clinical similarity with other dimorphic fungal infections (sometimes) make the diagnosis challenging. We report an immunocompromised patient with talaromycosis mimicking histoplamosis. A 26-year-old HIV-positive man had suffered from rashes over the face, trunk, and extremities for three months. His physical examination showed centrally necrotic, ulcerated papules and nodules. A biopsied papule revealed granulomas containing numerous oval, yeast-like cells, some displaying central septation. Saboraud agar culture grew mold with diffuse red pigment consistent with T. marneffei. Careful histopathological examination and microbiological culture are important for the accurate diagnosis of fungal infections.