Desai Anish, Fe Alexander, Desai Amishi, Ilowite Jonathan, Cunha Burke A, Mathew Joseph P
Conn Med. 2016 Feb;80(2):81-3.
Adult T-cell leukemia/lymphoma (ATLL) is usually preceded by infection with human T-cell lymphotropic virus I (HTLV-I). Patients with ATLL frequently get opportunistic infections of the lungs, intestines, and central nervous system. Pneumocystis pneumonia is commonly known as an AIDS defining illness. Grocott's methenamine silver stain of bronchoalveolar lavage (BAL) samples obtained via bronchoscopy remain the gold standard for diagnosis. Pulmonary cryptococcosis is seen in patients with T-cell deficiencies and a diagnosis is made by culture of sputum, BAL, or occasionally of pleural fluid. We present the second case of coinfection with these two organisms in a patient with ATLL who was successfully treated with trimethoprim-sulfamethoxazole, corticosteroids, and fluconazole. We illustrate the need for high clinical vigilance for seeking out an additional diagnosis, especially in immunocompromised patients if they are not improving despite receiving appropriate treatment.
成人T细胞白血病/淋巴瘤（ATLL）通常在感染人类T细胞嗜淋巴细胞病毒I（HTLV-I）之后发生。ATLL患者经常发生肺部、肠道和中枢神经系统的机会性感染。肺孢子菌肺炎通常被认为是艾滋病的定义性疾病。通过支气管镜检查获得的支气管肺泡灌洗（BAL）样本的格罗特甲基胺银染色仍然是诊断的金标准。肺隐球菌病见于T细胞缺陷患者，通过痰液、BAL或偶尔通过胸腔积液培养进行诊断。我们报告了第二例ATLL患者同时感染这两种病原体的病例，该患者接受甲氧苄啶-磺胺甲恶唑、皮质类固醇和氟康唑成功治疗。我们说明了对于寻求额外诊断需要保持高度临床警惕，特别是在免疫功能低下的患者中，如果他们在接受适当治疗后仍无改善。
