Elbadawi Ayman, Ahmed Hamdy M A, Adly Hussain, Elkhouly Mohamed A, Abohamed Samar, Falsey Ann R
Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA; Department of Cardiology, Ain Shams University, Cairo, Egypt.
Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA.
IDCases. 2016 Nov 25;7:23-24. doi: 10.1016/j.idcr.2016.11.006. eCollection 2017.
65 year-old-male presented with a one-week history of high grade fever, fatigue and confusion which began abruptly two days after a cystoscopy procedure. Past medical history included pulmonary sarcoidosis diagnosed by mediastinal lymph biopsy, diabetes and hypertension. On admission he was febrile and confused with stable vital signs. Initial workup included negative Head CT and lumbar puncture. Blood work revealed normal metabolic and liver function tests with progressive anemia, thrombocytopenia and atypical lymphocytosis of 15-20%. Blood, urine and respiratory cultures all were negative for bacteria and. A bone marrow biopsy was done given the abnormal lymphocytes in peripheral smear, revealing budding yeast consistent with . Histoplasma antigen was positive in urine and eventually blood and bone marrow grew . Patient was started on amphotericin-B for diagnosis of disseminated histoplasmosis. After a 2 week period of amphotericin B, patient was switched to oral Itraconazole to complete 12 months course of treatment.
一名65岁男性，在膀胱镜检查术后两天突然出现高热、乏力和意识模糊，病程一周。既往病史包括经纵隔淋巴结活检确诊的肺结节病、糖尿病和高血压。入院时发热且意识模糊，生命体征稳定。初步检查包括头颅CT和腰椎穿刺均为阴性。血液检查显示代谢和肝功能检查正常，但有进行性贫血、血小板减少以及15%-20%的非典型淋巴细胞增多。血液、尿液和呼吸道培养均未发现细菌。鉴于外周血涂片中有异常淋巴细胞，进行了骨髓活检，发现芽生酵母，符合荚膜组织胞浆菌。尿中荚膜组织胞浆菌抗原呈阳性，最终血液和骨髓培养出该菌。患者因播散性组织胞浆菌病诊断开始使用两性霉素B治疗。使用两性霉素B两周后，患者改用口服伊曲康唑完成12个月的疗程。
