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[一例胃肠道担子菌病致死病例]

[A letal case of gastro-intestinal basidiobolomycosis].

作者信息

Cazorla Arnault, Grenouillet Frédéric, Piton Gaël, Faure Étienne, Delabrousse Éric, Mathieu Pierre, Viennet Gabriel, Kantelip Bernadette, Millon Laurence, Valmary-Degano Séverine

机构信息

Service d'anatomie pathologique, CHRU Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon cedex, France.

Service de parasitologie, CHRU Jean-Minjoz, 25000 Besançon cedex, France; Université de Franche-Comté, 25000 Besançon, France.

出版信息

Ann Pathol. 2014 Jun;34(3):228-32. doi: 10.1016/j.annpat.2014.03.006. Epub 2014 May 22.

Abstract

We report here the case of a 55-year-old man from Mali, who presented with abdominal pain. Radiological exploration revealed an ileo-colonic mass surrounding the appendix. A biopsy was taken and on histology, transmural granulomatous inflammation of numerous eosinophils, lymphocytes, plasmocytes and giant cells was seen. Tuberculosis was suspected clinically and an antibiotic treatment was initiated. Two months later, the patient died of septic complications. Basidiobolus ranarum was identified by PCR. Pathogens were retrospectively highlighted on biopsies. These elements were between 10 and 15 μm in diameter, occasionally pseudo-septated, and were surrounded by a thick eosinophilic cuff. The thick eosinophilic cuff was identified as the Splendore-Hoeppli phenomenon. Basidiobolomycosis is a well-known infection in the tropical areas. Basidiobolus sp., fungus of the order Entomophtorales are a known cause of chronic subcutaneous mycosis. Gastro-intestinal basidiobolomycosis is rare and presents considerable diagnostic difficulty. This infection needs to be diagnosed because surgical resection and prolonged antifungal treatment are curable in most cases.

摘要

我们在此报告一例来自马里的55岁男性病例,该患者出现腹痛症状。影像学检查发现围绕阑尾的回结肠肿物。进行了活检,组织学检查可见大量嗜酸性粒细胞、淋巴细胞、浆细胞和巨细胞的透壁性肉芽肿性炎症。临床怀疑为结核病并开始使用抗生素治疗。两个月后,患者死于败血症并发症。通过聚合酶链反应(PCR)鉴定出蛙粪霉。在活检标本上回顾性发现了病原体。这些病原体直径在10至15微米之间,偶尔有假隔膜,周围有一层厚厚的嗜酸性带。这层厚厚的嗜酸性带被确认为斯普伦多雷-赫普现象。蛙粪霉病在热带地区是一种已知的感染。蛙粪霉属,虫霉目真菌是慢性皮下真菌病的已知病因。胃肠道蛙粪霉病很罕见,诊断存在相当大的困难。这种感染需要被诊断出来,因为在大多数情况下手术切除和长期抗真菌治疗是可治愈的。

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