Bao Fengchang, Tan Hongna, Liu Wei, Li Yange, Li Huixia
Department of Hematology, Children's Hospital, Zhengzhou, 255 Gangdu Road, Henan 450052, China.
Case Rep Pediatr. 2013;2013:563081. doi: 10.1155/2013/563081. Epub 2013 Jun 4.
We present a rare case of cryptococcal lymphadenitis without immunocompromization in a two-and-a-half-year-old child. He was referred to our center with a fifteen-day history of continued fever. Ultrasound and computed tomography (CT) revealed the enlargement of multiple lymph nodes and lung reticulonodular shadows. Hematological, immunological, and microbiological tests for hepatitis, lymphoma, AIDS, and immunoglobulin deficiencies were negative. Laboratory tests demonstrated elevated erythrocyte sedimentation rate, elevated plasma and urinary ß2-microglobulin (ß2-MG) levels, and elevated C-reactive protein and fibrinogen. Both blood routine and bone marrow aspiration showed elevated eosinophil granulocytes. The diagnosis of cryptococcal lymphadenitis was obtained by excisional biopsy of the cervical lymph nodes. The patient was treated with intravenous amphotericin B and oral flucytosine for five weeks, then with subsequent oral fluconazole for three months. The patient is now doing well. Our case suggests that the diagnosis of cryptococcal lymphadenitis is very difficult without etiology and pathology, especially for a patient with a normal immune system; lymph node biopsy is necessary to diagnose it, and immediate antifungal treatment is necessary to treat it.
我们报告了一例罕见的2岁半儿童隐球菌性淋巴结炎病例，该患儿无免疫功能低下情况。他因持续发热15天被转诊至我们中心。超声和计算机断层扫描（CT）显示多个淋巴结肿大及肺部网状结节阴影。针对肝炎、淋巴瘤、艾滋病和免疫球蛋白缺乏症的血液学、免疫学及微生物学检查均为阴性。实验室检查显示红细胞沉降率升高、血浆和尿β2微球蛋白（β2-MG）水平升高、C反应蛋白和纤维蛋白原升高。血常规和骨髓穿刺均显示嗜酸性粒细胞增多。通过颈部淋巴结切除活检确诊为隐球菌性淋巴结炎。患者接受了为期5周的静脉注射两性霉素B和口服氟胞嘧啶治疗，随后口服氟康唑3个月。患者目前情况良好。我们的病例表明，在没有病因和病理依据的情况下，隐球菌性淋巴结炎的诊断非常困难，尤其是对于免疫系统正常的患者；淋巴结活检对于诊断该病很有必要，而立即进行抗真菌治疗对于治疗该病很有必要。
