Penicillium Pneumonia in a Patient With Newly Diagnosed Franklin Disease

• Published in: The American journal of the medical sciences 2012-07, Vol.344 (1), p.69-71
• Main Authors: Weng, Chien-Hsiang, MD, Lin, Tseng-Hsi, MD, PhD, Hsieh, Tsu-Yi, MD, Tsai, Che-An, MD, Wang, Ren-Ching, MD
• Format: Article
• Language: English
• Subjects: Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; Autoimmune diseases; Biological and medical sciences; Diagnosis, Differential; Female; Franklin disease; Gamma heavy-chain disease; General aspects; Heavy Chain Disease - diagnosis; Heavy Chain Disease - immunology; Humans; Internal Medicine; Lung Diseases, Fungal - diagnosis; Lung Diseases, Fungal - drug therapy; Lung Diseases, Fungal - microbiology; Lupus Erythematosus, Systemic - immunology; Medical sciences; Middle Aged; Penicillium; Penicillium - isolation & purification; Penicillium infection; Pneumonia - diagnosis; Pneumonia - drug therapy; Pneumonia - microbiology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Systemic lupus erythematosus; Taiwan; Treatment Outcome
• ISSN: 0002-9629; 1538-2990
• DOI: 10.1097/MAJ.0b013e31824a8927

Abstract Franklin disease, or gamma heavy-chain disease, in patients with autoimmune disorders is a challenge for clinicians to diagnose due to its rarity, and recurrent infection is one of its characteristics. Within the spectrum of infections in Franklin disease patients, various fungi should always be considered. In this study, the authors describe a 57-year-old non-human immunodeficiency virus-infected systemic lupus erythematosus patient later diagnosed with Franklin disease and then developed Penicillium pneumonia. Because of the unexpected combination of Franklin disease and Penicillium infection in a non-human immunodeficiency virus-infected patient, the diagnosis of common hospital-acquired pneumonia was initially made. The laboratory examinations and cultures helped confirm the correct diagnosis of Franklin disease and Penicillium pneumonia. This is the first report of Penicillium sp. infection in a patient with Franklin disease, and it emphasizes the importance of proper preparation for biopsy, complete hematologic investigation, culture preparation and early antifungal coverage to improve the outcome.