Xiao Xue-Fei, Wu Jiong-Xing, Xu Yang-Cheng
Department of Emergency and Intensive Medicine, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China.
Department of Burn Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China.
World J Clin Cases. 2019 Aug 26;7(16):2374-2383. doi: 10.12998/wjcc.v7.i16.2374.
In recent years, the incidence of fungal infection has been increasing, often invading one or more systems of the body. However, it is rare for lymph nodes to be invaded without the involvement of other organs.
A 21-year-old man was admitted to hospital for repeated cough for 2 mo and abdominal pain for 1 mo. Physical examination revealed multiple lymph nodes enlargement, especially those in the left neck and groin. CT scan showed multiple lymph nodes enlargement in the chest, especially left lung, abdominal cavity, and retroperitoneum. The first lymph node biopsy revealed granulomatous lesions of lymph nodes, so intravenous infusion of Cefoperazone tazobactam combined with anti-tuberculosis drugs were given. Because fever and respiratory failure occurred 4 d after admission, mechanical ventilation was given, and Caspofungin and Voriconazole were used successively. However, the disease still could not be controlled. On the 11th day of admission, the body temperature reached 40° C. After mycosis of lymph nodes was confirmed by the second lymph node biopsy, Amphotericin B was given, and the patient recovered and was discharged from the hospital.
No fixed target organ was identified in this case, and only lymph node involvement was found. Caspofungin, a new antifungal drug, and the conventional first choice drug, Voriconazole, were ineffective, while Amphotericin B was effective.
近年来，真菌感染的发病率不断上升，常侵袭人体的一个或多个系统。然而，在没有其他器官受累的情况下，淋巴结受侵情况较为罕见。
一名21岁男性因反复咳嗽2个月、腹痛1个月入院。体格检查发现多处淋巴结肿大，尤其是左颈部和腹股沟的淋巴结。CT扫描显示胸部多处淋巴结肿大，尤其是左肺、腹腔和腹膜后。首次淋巴结活检显示淋巴结肉芽肿性病变，因此给予静脉输注头孢哌酮舒巴坦联合抗结核药物。入院4天后因出现发热和呼吸衰竭，给予机械通气，并先后使用了卡泊芬净和伏立康唑。然而，病情仍无法得到控制。入院第11天，体温达到40℃。第二次淋巴结活检确诊为淋巴结真菌病后，给予两性霉素B治疗，患者康复出院。
该病例未发现固定的靶器官，仅发现淋巴结受累。新型抗真菌药物卡泊芬净和传统首选药物伏立康唑均无效，而两性霉素B有效。
