一名服用他克莫司的患者发生隐孢子虫继发肝胆感染的病例。
A case of hepato-biliary infection secondary to cryptosporidium in a patient on tacrolimus.
作者信息
Gupta Sajal, Johnson Alison, Meyrick Simon, Davies Angharad P, Chalmers R
机构信息
Wye Valley NHS Trust, The County Hospital, Union Walk, Hereford, Herefordshire, HR1 2ER, UK.
Cryptosporidium Reference Unit, Public Health Wales Microbiology ABM, Singleton Hospital, Sgeti, Swansea, SA2 8QA, UK.
出版信息
JMM Case Rep. 2018 Jul 20;5(8):e005159. doi: 10.1099/jmmcr.0.005159. eCollection 2018 Aug.
INTRODUCTION
Cryptosporidium infection is known to cause hepato-biliary involvement, mainly in association with T-cell immune deficiency. Hepato-biliary involvement in association with milder immunosuppression is less well described. We describe the first case, to our knowledge, of hepato-biliary infection associated with tacrolimus in a patient with nephrotic syndrome.
CASE PRESENTATION
A 14 year old girl who had been on tacrolimus for nephrotic syndrome presented with diarrhea due to . Nineteen days after her initial presentation she attended hospital with abdominal pain and deranged liver function tests. An ultrasound scan showed a thickened gall bladder. Her symptoms settled and her liver function tests returned to normal after treatment with nitazoxanide.
CONCLUSION
Cryptosporidium should be considered in the differential diagnosis of both diarrhea and hepato-biliary symptoms and abnormal liver function tests, even in the presence of relatively mild immunosuppression. Nitazoxanide was an effective treatment in this case.
引言
已知隐孢子虫感染会导致肝胆系统受累，主要与T细胞免疫缺陷相关。与较轻免疫抑制相关的肝胆系统受累情况描述较少。据我们所知，我们描述了首例肾病综合征患者中与他克莫司相关的肝胆感染病例。
病例介绍
一名14岁因肾病综合征服用他克莫司的女孩出现腹泻。首次就诊19天后，她因腹痛和肝功能检查异常入院。超声扫描显示胆囊增厚。使用硝唑尼特治疗后，她的症状缓解，肝功能检查恢复正常。
结论
即使存在相对较轻的免疫抑制，在腹泻、肝胆系统症状及肝功能检查异常的鉴别诊断中也应考虑隐孢子虫感染。在本病例中，硝唑尼特是一种有效的治疗药物。
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