Bonsignore Alessandro, Orcioni Giulio Fraternali, Barranco Rosario, De Stefano Francesco, Ravetti Jean Louis, Ventura Francesco
University of Genova, Department of Legal and Forensic Medicine, Via De Toni 12, Genova 16132, Italy.
San Martino Hospital, Department of Clinical Pathology, Largo Rosanna Benzi 10, Genova 16132, Italy.
Leg Med (Tokyo). 2017 Mar;25:66-70. doi: 10.1016/j.legalmed.2017.01.008. Epub 2017 Jan 24.
Histoplasmosis is a relatively rare infectious disease endemic to certain geographic areas such as East Africa, eastern and central United States, western Mexico, Central and South America. Disseminated histoplasmosis has been reported mainly in immunocompromised hosts and in AIDS patients. In this paper we report on a fatal case of undiagnosed disseminated histoplasmosis presenting as fever of unknown origin (FUO) in a 43-year-old Italian woman who, although splenectomized 5years earlier due to a motor vehicle accident, was otherwise immunocompetent. This case report highlights the fact that, even in Europe, histoplasmosis is an emerging sporadic infection which needs be considered in the differential diagnosis of given clinical scenarios. The proposed case is of blatant forensic concern as it addresses the hypothesis of professional responsibility due to a missed diagnosis of histoplasmosis. A timely diagnosis, with appropriate therapies, could have prevented death. The role of the forensic pathologist is also crucial because the post-mortem diagnosis of histoplasmosis (never considered in the differential diagnosis during prior hospitalization) highlights the importance of a meticulous and thorough autopsy to elucidate the cause of death.
组织胞浆菌病是一种相对罕见的传染病，在某些地理区域呈地方性流行，如东非、美国东部和中部、墨西哥西部、中美洲和南美洲。播散性组织胞浆菌病主要见于免疫功能低下的宿主和艾滋病患者。本文报告了一例43岁意大利女性的致命性播散性组织胞浆菌病病例，该病例最初表现为不明原因发热（FUO），尽管患者5年前因机动车事故行脾切除术，但免疫功能正常。该病例报告强调，即使在欧洲，组织胞浆菌病也是一种新出现的散发性感染，在特定临床情况下的鉴别诊断中需要考虑。该病例引发了明显的法医关注，因为它涉及因组织胞浆菌病漏诊而导致职业责任的假设。及时诊断并给予适当治疗本可避免死亡。法医病理学家的作用也至关重要，因为组织胞浆菌病的尸检诊断（在之前住院期间的鉴别诊断中从未考虑过）凸显了细致全面的尸检对于明确死因的重要性。
