Hasliza M, Nur Atiqah N A, Lim C B, Hussain I H
Institute of Paediatrics, Hospital Kuala Lumpur, Jalan Pahang.
Med J Malaysia. 1999 Mar;54(1):120-4.
We describe a 2 year-old non-immunocompromised girl with disseminated histoplasmosis who presented with a 2-month history of fever and bloody diarrhoea. On presentation, she was severely wasted and anaemic. There were gross hepatosplenomegaly and multiple lymphadenopathy. A septic screen was negative. A subsequent stool culture isolated Salmonella enteriditis. Serial Widal-Weil Felix (WWF) titres showed serological response after 2 weeks of Ceftriaxone. However, she continued to have spiking fever, bloody diarrhoea and weight loss. She developed pancytopaenia and disseminated intravascular coagulation. A bone marrow aspirate and trephine, and lymph node biopsy showed the presence of Histoplasma capsulatum, confirmed by Gomori-Methenamine Silver staining. She responded to intravenous amphotericin B followed by fluconazole (intravenous then oral) for 6 months after discharge. Human Immunodeficiency Virus screening tests were negative. Complement and immunoglobulin levels were normal. T and B enumeration tests showed gross leucopaenia with very low T cell function with defective phagocytic function. A repeat T and B cell enumeration test and phagocytic function tests done 3 months later were normal.
我们描述了一名2岁非免疫功能低下的女孩，患有播散性组织胞浆菌病，有2个月的发热和血性腹泻病史。就诊时，她极度消瘦且贫血。有明显的肝脾肿大和多处淋巴结病。败血症筛查为阴性。随后的粪便培养分离出肠炎沙门氏菌。连续的肥达-魏尔费利克斯（WWF）滴度显示在头孢曲松治疗2周后出现血清学反应。然而，她仍持续有高热、血性腹泻和体重减轻。她出现了全血细胞减少和弥散性血管内凝血。骨髓穿刺和活检以及淋巴结活检显示存在荚膜组织胞浆菌，经戈莫里-亚甲胺银染色证实。出院后，她接受了静脉注射两性霉素B治疗，随后口服氟康唑6个月。人类免疫缺陷病毒筛查试验为阴性。补体和免疫球蛋白水平正常。T细胞和B细胞计数试验显示严重白细胞减少，T细胞功能极低，吞噬功能有缺陷。3个月后重复进行的T细胞和B细胞计数试验以及吞噬功能试验均正常。
