LAUSR

We report a 40yearold male AIDS patient who presented to our emergency department with chief complaints of generalized weakness, sore throat, stomachache, and weight loss in the previous two weeks. He was diagnosed with AIDS at an outside hospital when he was 18 years old. Physical examination showed poor general condition, oral thrush, hepatosplenomegaly, and generalized lymphadenopathy. There was no skin lesion on his face, trunk, or extremities. His complete blood cell counts revealed white blood cells 2.76 × 109/L, neutrophils 93.3%, hemoglobin 98 g/L, platelets 22 × 109/L, and nuclear red blood cells 6.8 × 109/L. Other abnormal laboratory results were blood urea nitrogen 33.5 μmol/L, serum creatinine 393.7 μmol/L, aspartic acid transferase 203 U/L, and lactate dehydrogenase 4,401 U/L. Peripheral blood smear examination showed many spherical and elliptical microorganisms (34 μm in size) with a clear central septum in the intracellular and extracellular spaces of neutrophils (Figure 1AH). The presumptive diagnosis was disseminated T. marneffei infection, which was confirmed by subsequent blood culture. The patient died of septic shock and multiorgan failure two days later.