Kashif Muhammad, Tariq Hassan, Ijaz Mohsin, Gomez-Marquez Jose
Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 10 C, Bronx, NY 10457, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 12 F, Bronx, NY 10457, USA.
Case Rep Crit Care. 2015;2015:295735. doi: 10.1155/2015/295735. Epub 2015 Aug 10.
Histoplasma duboisii, a variant of Histoplasma capsulatum that causes "African histoplasmosis," can be resistant to itraconazole, requiring intravenous amphotericin B treatment. Rarely, these patients do not respond to intravenous antifungal therapy, and in such cases, patients may progress to develop secondary hemophagocytic lymphohistiocytosis (HLH). We present a case of a 34-year-old male patient with sickle cell disease who presented with a 5-month history of an enlarging painless axillary mass, persistent low grade fevers, night sweats, weight loss, and anorexia. An excisional biopsy of the right axillary lymph node revealed yeast and granulomas consistent with histoplasma infection. He was started on oral itraconazole. After 4 weeks of therapy, laboratory evaluation revealed worsening anemia, thrombocytopenia, and transaminitis. Due to failure of oral therapy, he was admitted for intravenous amphotericin B treatment. During his hospital course anemia, thrombocytopenia, and transaminitis all worsened. A bone marrow biopsy was done that was consistent with HLH. His clinical status continued to deteriorate, developing multiorgan failure and disseminated intravascular coagulation. He unfortunately had a cardiorespiratory arrest after eight days of admission and passed away.
杜波伊斯组织胞浆菌是荚膜组织胞浆菌的一个变种，可引起“非洲组织胞浆菌病”，对伊曲康唑耐药，需要静脉注射两性霉素B治疗。这些患者很少对静脉抗真菌治疗无反应，在这种情况下，患者可能会进展为继发性噬血细胞性淋巴组织细胞增生症（HLH）。我们报告一例34岁患有镰状细胞病的男性患者，他有一个5个月来逐渐增大的无痛性腋窝肿块病史，伴有持续低热、盗汗、体重减轻和厌食。右侧腋窝淋巴结切除活检显示有酵母和肉芽肿，符合组织胞浆菌感染。他开始接受口服伊曲康唑治疗。治疗4周后，实验室评估显示贫血、血小板减少和转氨酶升高加重。由于口服治疗失败，他入院接受静脉注射两性霉素B治疗。在住院期间，贫血、血小板减少和转氨酶升高均加重。进行了骨髓活检，结果符合HLH。他的临床状况持续恶化，发展为多器官功能衰竭和弥散性血管内凝血。不幸的是，入院8天后他发生了心肺骤停并去世。
