Shahani Lokesh
Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston, Houston, Texas, USA.
BMJ Case Rep. 2018 Jun 28;2018:bcr-2018-224498. doi: 10.1136/bcr-2018-224498.
Histoplasma microconidia when inhaled are presented in antigenic form to T cells, limiting the extent of infection; however, defects in cellular immunity results in disseminated disease. Chronic lymphocytic leukaemia (CLL) is a lymphoproliferative disorder resulting in functionally impaired lymphocytes, predisposing patients to various opportunistic infections. The author reports a recently treated patient with CLL presenting with constitutional symptoms accompanied by hepatosplenomegaly and diffuse adenopathy. Considering the recent diagnosis and treatment of CLL, initial suspicion was relapsed disease. However, considering the immune deficiency associated with CLL and its treatment, infectious aetiologies were strongly considered. Further investigation revealed a case of disseminated histoplasmosis mimicking CLL in this reported patient. Considering appropriate diagnosis and timely therapy, the reported patient had good prognosis despite being diagnosed with disseminated histoplasmosis. This case highlights consideration of disseminated histoplasmosis in patients presenting with diffuse adenopathy along with hepatomegaly and/or splenomegaly in the right clinical setting.
吸入的荚膜组织胞浆菌小分生孢子以抗原形式呈递给T细胞，限制了感染的程度；然而，细胞免疫缺陷会导致播散性疾病。慢性淋巴细胞白血病（CLL）是一种淋巴细胞增殖性疾病，导致淋巴细胞功能受损，使患者易发生各种机会性感染。作者报告了一名近期接受治疗的CLL患者，该患者出现全身症状，伴有肝脾肿大和弥漫性淋巴结病。考虑到CLL的近期诊断和治疗情况，最初怀疑是疾病复发。然而，考虑到与CLL及其治疗相关的免疫缺陷，强烈怀疑是感染性病因。进一步调查发现，该报告患者患有一种模仿CLL的播散性组织胞浆菌病。考虑到适当的诊断和及时的治疗，该报告患者尽管被诊断为播散性组织胞浆菌病，但预后良好。该病例强调了在正确的临床背景下，对于出现弥漫性淋巴结病以及肝肿大和/或脾肿大的患者，应考虑播散性组织胞浆菌病。
