Mawhorter S D, Curley G V, Kursh E D, Farver C E
Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Clin Infect Dis. 2000 Mar;30(3):595-8. doi: 10.1086/313699.
Histoplasmosis is a common cause of systemic mycosis in areas of the United States where it is endemic. Central nervous system and genitourinary histoplasmosis is rare, especially in immunocompetent hosts. We describe a case of disseminated histoplasmosis in a normal host that was associated with cerebral and prostatic histoplasmosis presenting as fever of undetermined origin, weight loss, and severe debilitating altered mental status. The patient subsequently developed acute renal failure that manifested as obstructive uropathy during antifungal therapy with amphotericin B. Transurethral resection of the prostate resulted in improved renal function during continuation of amphotericin B therapy. Pathological analysis of the prostate revealed necrotizing granulomas with intralesional fungal organisms. Blood and urine cultures were positive for Histoplasma capsulatum. Diagnostic issues and management are discussed. Treatment resulted in return of normal cognitive and motor function. This case is compared with the 8 previously reported cases of H. capsulatum prostatitis.
组织胞浆菌病是美国该病流行地区系统性真菌病的常见病因。中枢神经系统和泌尿生殖系统组织胞浆菌病较为罕见，尤其是在免疫功能正常的宿主中。我们描述了一例正常宿主播散性组织胞浆菌病病例，该病例伴有脑和前列腺组织胞浆菌病，表现为不明原因发热、体重减轻和严重的精神状态改变导致身体衰弱。患者随后出现急性肾衰竭，在使用两性霉素B进行抗真菌治疗期间表现为梗阻性尿路病。经尿道前列腺切除术在继续使用两性霉素B治疗期间使肾功能得到改善。前列腺病理分析显示坏死性肉芽肿，病灶内有真菌生物体。血液和尿液培养显示荚膜组织胞浆菌阳性。文中讨论了诊断问题和治疗方法。治疗使患者恢复了正常的认知和运动功能。将该病例与之前报道的8例荚膜组织胞浆菌前列腺炎病例进行了比较。
