Xiong Xiao-Feng, Fan Li-Li, Kang Mei, Wei Jia, Cheng De-Yun
Department of Respiratory and Critical Care Medicine West China Hospital of Sichuan University Chengdu Sichuan China.
Department of Clinical Laboratory Medicine West China Hospital of Sichuan University Chengdu Sichuan China.
Respirol Case Rep. 2017 Feb 26;5(3):e00220. doi: 10.1002/rcr2.220. eCollection 2017 May.
We describe a rare and interesting case of a 37-year-old man who presented with an intermittent fever, progressive cytopenia, and hepatosplenomegaly. Histopathological examination of a bone marrow smear revealed haemophagocytes and intracellular yeast-like Histoplasma capsulatum (H. capsulatum); thus, we prolonged the blood culture duration to detect fungi, and H. capsulatum was detected in the peripheral blood. After the diagnosis of disseminated histoplasmosis, the patient was successfully treated with amphotericin B and symptomatic therapy. This is the first case in southwest China for which H. capsulatum was cultivated in peripheral blood, illustrating that the duration of specimen culture should be lengthened if a specific pathogen infection is suspected. Moreover, this case enriches our understanding of clinical manifestations of disseminated histoplasmosis.
我们描述了一例罕见且有趣的病例，患者为一名37岁男性，表现为间歇性发热、进行性血细胞减少和肝脾肿大。骨髓涂片的组织病理学检查发现噬血细胞和细胞内酵母样荚膜组织胞浆菌；因此，我们延长了血培养时间以检测真菌，并在外周血中检测到了荚膜组织胞浆菌。在诊断为播散性组织胞浆菌病后，患者接受两性霉素B及对症治疗，治疗成功。这是中国西南部首例在外周血中培养出荚膜组织胞浆菌的病例，说明如果怀疑有特定病原体感染，应延长标本培养时间。此外，该病例丰富了我们对播散性组织胞浆菌病临床表现的认识。
