Jha Dharmendra Kumar, Jha Anshu Kumar, Singh Rajeev Kumar
Department of Medicine, Patliputra Medical College and Hospital, Saraidhela, Post Office- Koyla Nagar, Dhanbad, Jharkhand, India.
Department of Medicine, Assam Medical College and Hospital, Dibrugarh, Assam 786002, India.
Oxf Med Case Reports. 2018 Oct 17;2018(11):omy083. doi: 10.1093/omcr/omy083. eCollection 2018 Nov.
A patient complained of fever on and off, difficulty in swallowing and cough (with scanty expectoration) since one and a half months and weight loss over 2 months. On examination, pallor was found to be present. Then ultrasonography of abdomen was done and it showed mesenteric and retroperitoneal lymphadenopathy. Sputum for acid-fast Bacilli was examined and found to be negative but despite this, based on the epidemiological data, antitubercular therapy (ATT) was started but after 2 weeks no clinical improvement was found. Then, fine-needle aspiration cytology of lymph node was done and it resulted in the presence of cryptococcal lymphadenitis as the final report. Antifungal therapy was initiated with amphotericin B followed by fluconazole and there was clinical improvement. Ultrasonographical findings also supported it. Though it is a rare case (but not impossible) that cryptococcus is the cause of lymphadenopathy. Thus, in initial presentation of acquired immuno deficiency syndrome it should always be kept in mind that such cases may happen. In India, presuming as the leading cause exposes the patient to unwanted hepatic and renal toxicity of ATT.
一名患者自述一个半月以来持续间歇性发热、吞咽困难并伴有咳嗽（咳痰量少），且在两个多月内体重减轻。检查时发现患者面色苍白。随后进行了腹部超声检查，结果显示肠系膜及腹膜后淋巴结肿大。痰涂片抗酸杆菌检查结果为阴性，但基于流行病学数据，仍开始了抗结核治疗（ATT），然而两周后未见临床症状改善。之后进行了淋巴结细针穿刺细胞学检查，最终报告显示为隐球菌性淋巴结炎。开始使用两性霉素B进行抗真菌治疗，随后改用氟康唑，患者临床症状有所改善。超声检查结果也支持这一诊断。虽然隐球菌作为淋巴结肿大病因的情况较为罕见（但并非不可能），但在获得性免疫缺陷综合征的初始表现中，应始终牢记可能出现此类病例。在印度，若将结核病假定为主要病因，会使患者遭受抗结核治疗带来的不必要的肝脏和肾脏毒性。
