van Doorn-Schepens M L M, Peters E J, van Vugt R M, van der Spoel J I, van Dijk K
Department of Medical Microbiology and Infection Control, VU University Medical Center , Amsterdam , the Netherlands.
Department of Internal Medicine, VU University Medical Center , Amsterdam , the Netherlands.
JMM Case Rep. 2016 Aug 30;3(4):e005035. doi: 10.1099/jmmcr.0.005035. eCollection 2016 Aug.
Diagnosing progressive disseminated histoplasmosis (PDH) in patients with systemic lupus erythematosus (SLE) is diagnostically challenging. Since PDH is lethal when untreated, awareness of this infection in patients with SLE is of utmost importance. To the best of our knowledge, this is the first description of a case of PDH in a patient with SLE in Europe.
A 56-year-old woman of Surinamese descent with a history of SLE, presented with fever and polyarthritis. Although a flare of SLE was suspected initially, cultures of bone marrow and broncho-alveolar lavage fluid grew .
This case report highlights that physicians should be aware of progressive disseminated histoplasmosis in patients with SLE treated with immunosuppressive agents. The signs and symptoms can easily mimic a SLE flare, which would then be treated with more aggressive immunosuppression. Failure to recognize the infection will therefore invariably lead to death of the patient. Progressive disseminated histoplasmosis is usually not recognized by doctors in non-endemic areas such as Europe. However, globalisation and more frequent intercontinental traffic of immunocompromised patients currently increases the incidence of histoplasmosis in these areas. It is therefore of life-saving importance that doctors are aware of the features of the infection in areas where is not endemic.
诊断系统性红斑狼疮（SLE）患者的进行性播散性组织胞浆菌病（PDH）具有诊断挑战性。由于PDH未经治疗会致死，因此SLE患者对这种感染的认知至关重要。据我们所知，这是欧洲首例关于SLE患者发生PDH的病例描述。
一名56岁有苏里南血统且有SLE病史的女性，出现发热和多关节炎。虽然最初怀疑是SLE病情复发，但骨髓和支气管肺泡灌洗液培养结果显示……
本病例报告强调，医生应意识到接受免疫抑制剂治疗的SLE患者会发生进行性播散性组织胞浆菌病。其体征和症状很容易被误诊为SLE病情复发，进而采用更积极的免疫抑制治疗。因此，未能识别该感染必然会导致患者死亡。在欧洲等非流行地区，医生通常不认识进行性播散性组织胞浆菌病。然而，全球化以及免疫功能低下患者更频繁的洲际流动目前增加了这些地区组织胞浆菌病的发病率。因此，医生了解非流行地区该感染的特征具有挽救生命的重要意义。
