慢性阻塞性肺疾病（COPD）免疫功能正常患者发生马尔尼菲青霉血症：一例独特病例报告
Fungemia caused by Penicillium marneffei in an immunocompetent patient with COPD: A unique case report.
作者信息
Yu Xiaoming, Cai Xueding, Xu Xiaomei, Zhang Lin, Huang Xiaoying, Wang Liangxing, Chen Yanfan
机构信息
Division of Pulmonary Medicine, The People's Hospital of Cangnan, Wenzhou Medical University, Cangnan Division of Pulmonary Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
出版信息
Medicine (Baltimore). 2018 Jan;97(3):e9658. doi: 10.1097/MD.0000000000009658.
RATIONALE
This report describes a rare case in Wenzhou city of Zhejiang province that a non-HIV infected male recovering from fungemia caused by Penicillium marneffei (P. marneffei). Interestingly, it's very easy to misdiagnose with aspergillosis, a fungal disease prevalent in Wenzhou, during the whole procedure.
PATIENT CONCERNS
An 80-year-old Chinese male subject with pre-existing chronic obstructive pulmonary disease (COPD) presented with symptoms of chest tightness and high fever for a month.
DIAGNOSES
Fungal culture from the blood isolated P marneffei. Naturally, the patient was diagnosed with P marneffei fungemia. However, he was proven serologically to be negative for human immunodeficiency virus (HIV).
INTERVENTIONS
The patient was treated with voriconazole at 200mg/dL every 12 hours via intravenous administration.
OUTCOMES
The fever returned to normal and chest tightness disappeared gradually after a week of voriconazole treatment.
LESSONS
A high level of clinical suspicion and awareness is necessary for early diagnosis of P marneffei fungemia, especially in elder patients with underlying diseases.
原理
本报告描述了浙江省温州市的一个罕见病例，一名未感染艾滋病毒的男性从马尔尼菲青霉（P. marneffei）引起的真菌血症中康复。有趣的是，在整个过程中，很容易误诊为温州流行的真菌病曲霉菌病。
患者情况
一名80岁的中国男性患者，既往有慢性阻塞性肺疾病（COPD），出现胸闷和高热症状一个月。
诊断
血液真菌培养分离出马尔尼菲青霉。自然地，该患者被诊断为马尔尼菲青霉真菌血症。然而，血清学检测证明他的人类免疫缺陷病毒（HIV）呈阴性。
干预措施
患者接受伏立康唑治疗，静脉注射，每12小时200mg/dL。
结果
伏立康唑治疗一周后，发热恢复正常，胸闷逐渐消失。
经验教训
对于马尔尼菲青霉真菌血症的早期诊断，尤其是对有基础疾病的老年患者，需要高度的临床怀疑和意识。
Zotero 插件