Subedee Anup, Van Sickels Nicholas
Baton Rouge General Medical Center, Internal Medicine Residency Program, Baton Rouge, LA, USA
Tulane University Infectious Diseases Fellowship Program, New Orleans, LA, USA.
J Int Assoc Provid AIDS Care. 2015 Sep-Oct;14(5):391-7. doi: 10.1177/2325957415570740. Epub 2015 Feb 10.
Hemophagocytic lymphohistiocytosis (HLH) is traditionally regarded as a rapidly progressive and often fatal illness. In patients with AIDS, HLH usually occurs secondary to opportunistic infections. Although popular guidelines exist for the diagnosis and management of HLH in general, no formal study has evaluated their applicability among adult patients who develop HLH in the setting of AIDS and opportunistic infections. The study reports on a case of HLH in a patient with AIDS and disseminated histoplasmosis. Eighteen other previously reported cases of HLH in the setting of AIDS and histoplasmosis were reviewed. Majority of the cases occurred in patients with a CD4 count of less than 70 cells/mm(3). Overall mortality was 44%. Not getting antifungal treatment and having Histoplasma in blood were the 2 main risk factors for death. Among the patients who had a timely diagnosis of histoplasmosis and were initiated on antifungal therapy, the survival rates were significantly better, especially in the post-2000 ad period.
噬血细胞性淋巴组织细胞增生症（HLH）传统上被认为是一种进展迅速且往往致命的疾病。在艾滋病患者中，HLH通常继发于机会性感染。尽管一般存在关于HLH诊断和管理的通用指南，但尚无正式研究评估其在艾滋病合并机会性感染且发生HLH的成年患者中的适用性。该研究报告了1例艾滋病合并播散性组织胞浆菌病患者发生HLH的病例。还回顾了其他18例先前报告的艾滋病合并组织胞浆菌病患者发生HLH的病例。大多数病例发生在CD4细胞计数低于70个/mm³的患者中。总体死亡率为44%。未接受抗真菌治疗和血液中存在组织胞浆菌是两个主要死亡危险因素。在及时诊断组织胞浆菌病并开始抗真菌治疗的患者中，生存率明显更高，尤其是在公元2000年后。
