Ocon Anthony J, Bhatt Birju D, Miller Cynthia, Peredo Ruben A
Division of Rheumatology, Department of Medicine, Albany Medical Center, Albany, New York, USA.
Division of Infectious Disease, Department of Medicine, Albany Medical Center, Albany, New York, USA.
BMJ Case Rep. 2017 Oct 4;2017:bcr-2017-221264. doi: 10.1136/bcr-2017-221264.
Hemophagocytic lymphohistiocytosis (HLH) is a serious life-threatening disease if not recognised early. In patients with HIV/AIDS, this association has been reported following acute opportunistic infections, including histoplasmosis. However, optimal treatment is not known. We describe a male aged 46 years with AIDS who developed HLH following acute disseminated histoplasmosis. Presenting symptoms included fever, hepatosplenomegaly and pancytopenia. Bone marrow biopsy confirmed HLH. Initially, he was refractory to the treatment with amphotericin B, antiretroviral therapy and intravenous immunoglobulin (IVIG). Anakinra, an interleukin-1 receptor antagonist, and dexamethasone were initiated. He improved clinically, did not exhibit any harmful effects and ultimately was discharged from the hospital. This, we believe, is the first reported treatment of HLH with anakinra in a patient with AIDS and acute disseminated histoplasmosis.
噬血细胞性淋巴组织细胞增生症（HLH）若不及早识别，是一种严重的、危及生命的疾病。在艾滋病毒/艾滋病患者中，急性机会性感染（包括组织胞浆菌病）后曾有这种关联的报道。然而，最佳治疗方法尚不清楚。我们描述了一名46岁患艾滋病的男性，其在急性播散性组织胞浆菌病后发生了HLH。呈现的症状包括发热、肝脾肿大和全血细胞减少。骨髓活检确诊为HLH。起初，他对两性霉素B、抗逆转录病毒疗法和静脉注射免疫球蛋白（IVIG）治疗无效。开始使用阿那白滞素（一种白细胞介素-1受体拮抗剂）和地塞米松。他临床症状改善，未出现任何有害影响，最终出院。我们认为，这是首例关于用阿那白滞素治疗艾滋病合并急性播散性组织胞浆菌病患者HLH的报道。
