Goel Deepa, Prayaga Aruna K, Rao Nageshwar, Damodaram Potikuri
Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, India.
Acta Cytol. 2007 Jan-Feb;51(1):89-91. doi: 10.1159/000325691.
Histoplasmosis, extrapulmonary or disseminated, with positive HIV serology is an indicator of AIDS. Infection by Histoplasma capsulatum (HC) has been found on fine needle aspiration cytology (FNAC) in the lung, breast, adrenal, gastrointestinal tract, lymph nodes, subcutaneous tissues and other sites. We could not find any reports of isolated nodular myositis caused by HC and diagnosed on FNAC.
A 42-year-old, HIV-1-positive, heterosexual man presented with generalized myalgia, fever and multiple painful nodules in the skeletal muscles. The CD4 count was 66 cells per microliter. FNAC from multiple nodules contained numerous intracytoplasmic and a few extracellular, 3-5-microm, oval, pale yeasts, occasionally showing single budding with a narrow base. Morphology of the yeasts, as demonstrated by May-Grünwald-Giemsa and Gomori methenamine silver stain, was characteristic of HC. The patient's condition improved, and the nodules disappeared rapidly within 5 days of treatment with fluconazole, 400 mg daily.
The cytomorphology of HC is characteristic. An unusual presentation of rare infections can cause considerable diagnostic difficulties for both the clinician and cytopathologist. Awareness of these rarities is important to ensure optimal patient care. Thus, the role of FNAC is critical and remains unchallenged.
肺外或播散性组织胞浆菌病，HIV血清学检测呈阳性是艾滋病的一项指标。在肺、乳腺、肾上腺、胃肠道、淋巴结、皮下组织及其他部位的细针穿刺细胞学检查（FNAC）中已发现荚膜组织胞浆菌（HC）感染。我们未找到任何关于由HC引起并经FNAC诊断的孤立性结节性肌炎的报告。
一名42岁、HIV-1阳性的异性恋男性，出现全身肌肉疼痛、发热及骨骼肌多个疼痛性结节。CD4细胞计数为每微升66个细胞。。多个结节的FNAC显示有大量胞浆内及少数细胞外的3-5微米椭圆形淡色酵母，偶尔可见窄基单芽。经May-Grünwald-Giemsa和Gomori甲胺银染色显示的酵母形态具有HC的特征。患者病情改善，在每日服用400毫克氟康唑治疗5天内结节迅速消失。
HC的细胞形态学具有特征性。罕见感染的不寻常表现可能给临床医生和细胞病理学家带来相当大的诊断困难。认识到这些罕见情况对于确保最佳患者护理很重要。因此，FNAC的作用至关重要且无可替代。
