Yamaguchi Hiromichi, Komase Yuko, Ikehara Mizuki, Yamamoto Takahito, Shinagawa Toshihito
Department of Respiratory Internal Medicine, St. Marianna University School of Medicine, Yokohama-city Seibu Hospital, 1197-1 Yasashi-cho, Asahi-ku, Yokohama 241-0811, Japan.
J Infect Chemother. 2008 Aug;14(4):319-24. doi: 10.1007/s10156-008-0618-z. Epub 2008 Aug 17.
A 23-year-old man with no recent medical history was hospitalized complaining of high fever and cough. In addition to very marked eosinophilia, chest X-ray revealed extensive bronchovascular bundle thickening. Transbronchial lung biopsy (TBLB) showed moderate eosinophil infiltration. Cryptococcus neoformans infection was diagnosed, based on blood culture, cerebrospinal fluid culture, urine culture, and lung biopsy specimens. The eosinophilia was successfully alleviated by treatment for cryptococcal meningitis. Furthermore, cryptococcal sepsis resolved with amphotericin B and 5-flucytosine treatment. Eosinophilia commonly occurs following chronic Aspergillus infection, but the present case suggests the involvement of Cryptococcus in another mechanism for eosinophilia.
一名无近期病史的23岁男性因高热和咳嗽入院。除了非常明显的嗜酸性粒细胞增多外,胸部X线显示广泛的支气管血管束增厚。经支气管肺活检(TBLB)显示中度嗜酸性粒细胞浸润。根据血培养、脑脊液培养、尿培养和肺活检标本诊断为新型隐球菌感染。通过治疗隐球菌性脑膜炎,嗜酸性粒细胞增多症得到成功缓解。此外,两性霉素B和5-氟胞嘧啶治疗使隐球菌败血症得以治愈。嗜酸性粒细胞增多症通常在慢性曲霉感染后发生,但本病例提示隐球菌通过另一种机制导致嗜酸性粒细胞增多。