de Borst Martin H, van Zeijl Jan H, Grond Joris, Hoogendoorn Mels
Medisch Centrum Leeuwarden, afd. Interne Geneeskunde, Leeuwarden, The Netherlands.
Ned Tijdschr Geneeskd. 2010;154:A1157.
A 69-year-old man with chronic lymphocytic leukemia presented with fever and a productive cough. He was diagnosed with a histoplasmosis infection, caused by the dimorphic fungus Histoplasma capsulatum, which is rare in the Netherlands but endemic in parts of the United States and South America. The patient was treated with high doses of itraconazole and gamma globulin infusions. This initially led to a clinical improvement, but eventually he developed a probable progressive histoplasmosis. The patient refused additional treatment and died. In immunocompromised patients, infections of the respiratory tract can be caused by a broad variety of agents. Knowledge of the patient's travel history is crucial to determine or exclude certain causal agents.
一名69岁的慢性淋巴细胞白血病男性患者出现发热和咳痰。他被诊断为组织胞浆菌病感染，由二态真菌荚膜组织胞浆菌引起，这种真菌在荷兰罕见，但在美国和南美洲部分地区为地方病。患者接受了高剂量伊曲康唑和静脉注射丙种球蛋白治疗。这最初带来了临床改善，但最终他可能发展为进行性组织胞浆菌病。患者拒绝进一步治疗并死亡。在免疫功能低下的患者中，呼吸道感染可由多种病原体引起。了解患者的旅行史对于确定或排除某些病原体至关重要。
