Huss R, Landolt U, Schär G, Greminger P, Schwery S, Meyenberger C, Waller C, Siegenthaler W, Lüthy R, Vogt M
Departement für Innere Medizin, Universität Zürich.
Dtsch Med Wochenschr. 1990 Sep 7;115(36):1353-7. doi: 10.1055/s-2008-1065164.
A 29-year-old man who had been abroad for several years (mainly Mexico) fell ill with fever (up to 39.8 degrees C), night sweats, weight loss of 10 kg in 6 months (height 181 cm, weight 50.5 kg) and abdominal pain. Computed tomography of the abdomen revealed many enlarged abdominal lymph nodes. Serological tests were positive for HIV antibodies. Fine-needle biopsy of one of the enlarged lymph nodes revealed numerous macrophages with round inclusions, typical for Histoplasma capsulatum. Disseminated histoplasmosis was confirmed by direct antigen demonstration in serum and urine. The patient's serious clinical condition clearly improved and lymph node enlargement regressed after starting specific i.v. treatment with amphotericin B (initially 20 mg/dl, then 50 mg/dl). Although complete cure of the histoplasmosis in connection with the HIV infection is not to be expected, the patient has remained without symptoms for four months on 50 mg weekly of amphotericin B i.v., later changed to imidazole derivatives (400 mg ketoconazole or 200 mg itraconazole, respectively.
一名曾在国外（主要是墨西哥）待过数年的29岁男子患病，出现发热（体温高达39.8摄氏度）、盗汗、6个月内体重减轻10公斤（身高181厘米，体重50.5公斤）以及腹痛症状。腹部计算机断层扫描显示腹部有许多肿大的淋巴结。血清学检测HIV抗体呈阳性。对其中一个肿大淋巴结进行细针穿刺活检，发现大量带有圆形包涵体的巨噬细胞，这是荚膜组织胞浆菌的典型表现。血清和尿液中的直接抗原检测证实为播散性组织胞浆菌病。在用两性霉素B进行特异性静脉治疗后（初始剂量为20毫克/分升，随后为50毫克/分升），患者严重的临床状况明显改善，淋巴结肿大消退。虽然预计无法完全治愈与HIV感染相关的组织胞浆菌病，但患者在每周静脉注射50毫克两性霉素B的情况下无症状维持了四个月，之后改为咪唑衍生物（分别为400毫克酮康唑或200毫克伊曲康唑）。
