Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA.
Am J Transplant. 2010 Mar;10(3):687-91. doi: 10.1111/j.1600-6143.2009.02969.x. Epub 2010 Feb 1.
Transplant patients are susceptible to infectious complications due to chronic immunosuppression. We present two cases of persistent fever, weight loss and pancytopenia in kidney transplant recipients (originally concerning for posttransplant lymphoproliferative disease) that were later diagnosed with disseminated histoplasmosis on bone marrow and lymph node biopsy. In both patients, pancytopenia was due to hemophagocytic lymphohistiocytosis (HLH) which has rarely been described in association with histoplasmosis and not previously reported in kidney transplant recipients with this fungal infection. The diagnosis of histoplasmosis can be complex due to nonspecific symptomatology, delays in isolating histoplasma by fungal culture and false-negative antibody titers in immunocompromised patients. A review of the literature including the clinical features of histoplasmosis in immunosuppressed patients (prevalence, current diagnostic testing and treatment options) as well as the association of HLH in immunocompromised states are discussed.
移植患者由于慢性免疫抑制而易发生感染并发症。我们报告了两例肾移植受者持续发热、体重减轻和全血细胞减少症的病例（最初怀疑为移植后淋巴组织增生性疾病），后来在骨髓和淋巴结活检中诊断为播散性组织胞浆菌病。在这两例患者中，全血细胞减少症是由于噬血细胞性淋巴组织细胞增生症（HLH）引起的，HLH 与组织胞浆菌病相关的情况很少见，也没有在接受这种真菌感染的肾移植受者中报道过。由于症状不典型、真菌培养分离出组织胞浆菌的时间延迟以及免疫功能低下患者的抗体滴度假阴性，组织胞浆菌病的诊断可能很复杂。本文回顾了文献，包括免疫抑制患者组织胞浆菌病的临床特征（患病率、当前的诊断检测和治疗选择）以及免疫抑制状态下 HLH 的相关性。
