PDF(Pubmed)
Abstract：
Histoplasmosis commonly presents as an asymptomatic or self-limited infection in immunocompetent patients, but immunocompromised hosts may present with severe and disseminated disease. Herein, we present a 26-year-old male with history of ulcerative colitis receiving long-term TNF-alpha inhibitor therapy who presented with six months of diarrhea and recently fever and hematochezia. On admission, he was febrile and hypotensive, with initial workup revealing pancytopenia and imaging reporting pulmonary infiltrates, pancolitis, and enlarged mesenteric lymph nodes. Disseminated histoplasmosis was ultimately diagnosed after examination of the colonic biopsy. Bone marrow biopsy was also consistent with the diagnosis of histoplasmosis but also demonstrated hemophagocytic lymphohistiocytosis. The patient was ultimately treated with amphotericin B, intravenous immunoglobulin, etoposide, and corticosteroids.
摘要：
在免疫功能正常的患者中，组织胞浆菌病通常表现为无症状或自限感染。但是免疫功能低下的宿主可能存在严重和播散性疾病。在这里，我们介绍了一名26岁男性,有溃疡性结肠炎病史,接受长期TNF-α抑制剂治疗,出现6个月腹泻,近期发热和便血.一入场,他有高热和低血压,初步检查显示全血细胞减少症和影像学报告肺浸润，泛结肠炎,肠系膜淋巴结肿大。在结肠活检检查后最终诊断为播散性组织胞浆菌病。骨髓活检也与组织胞浆菌病的诊断一致，但也显示了噬血细胞性淋巴组织细胞增多症。患者最终接受两性霉素B治疗，静脉注射免疫球蛋白，依托泊苷,和皮质类固醇。
