Mayo Clinic, Jacksonville, FL, USA.
Mayo Clinic, Rochester, MN, USA.
Hand (N Y). 2021 May;16(3):277-284. doi: 10.1177/1558944720911212. Epub 2020 Mar 22.
: Histoplasmosis of the upper extremities is extremely rare, and there is no consensus in its management. The aim of this study was to present a case report and literature review of histoplasmosis in the upper extremities to provide the best treatment recommendation and to increase awareness of this disease. : A systematic review of the literature was performed in PubMed, MEDLINE, and EMBASE databases with the search terms "(Tenosynovitis AND histoplasmosis)" OR "(Upper limbs AND histoplasmosis)" OR "(Upper extremities AND histoplasmosis)" OR "((finger OR arm OR hand OR forearm OR wrist) AND histoplasmosis)." Manuscripts were included in the study if they described diagnosis of histoplasmosis in the bone, joint, synovia, or tendons of the upper extremities. : In all, 14 manuscripts and 15 cases of histoplasmosis of the upper extremities from 1992 to 2015 met the inclusion criteria. Eight (53.3%) patients were diagnosed with tenosynovitis, 5 (33.3%) with osteomyelitis, 1 (6.7%) with carpal tunnel syndrome, and 1 (6.7%) with joint wrist abscess. Immunosuppression, travel history, previous diagnosis with histoplasmosis, and persistent symptoms may suggest infectious causes. Surgery and medical treatment together are recommended to optimize outcomes compared with single treatment alone. : Histoplasmosis of the upper extremities may have various clinical presentations, including tenosynovitis, osteomyelitis, carpal tunnel syndrome, and joint wrist abscess. The type of surgical approach may depend on the etiology of disease. Increased awareness and knowledge of the clinical signs, symptoms, and effective treatment modalities will help decrease possible complications, such as tendon rupture and functional impairment of the upper extremities.
: 上肢的组织胞浆菌病极为罕见，其治疗方法尚未达成共识。本研究旨在报告上肢组织胞浆菌病的病例报告和文献复习，为提供最佳治疗建议和提高对该病的认识提供参考。: 在 PubMed、MEDLINE 和 EMBASE 数据库中进行了系统的文献复习，检索词为“(腱鞘炎 AND 组织胞浆菌病)”或“(上肢 AND 组织胞浆菌病)”或“(上肢 AND 组织胞浆菌病)”或“((手指 OR 手臂 OR 手 OR 前臂 OR 手腕) AND 组织胞浆菌病)”。如果文献描述了上肢骨骼、关节、滑膜或肌腱的组织胞浆菌病的诊断，则将其纳入研究。: 共有 14 篇文献和 1992 年至 2015 年的 15 例上肢组织胞浆菌病病例符合纳入标准。8 例（53.3%）患者被诊断为腱鞘炎，5 例（33.3%）为骨髓炎，1 例（6.7%）为腕管综合征，1 例（6.7%）为腕关节脓肿。免疫抑制、旅行史、既往组织胞浆菌病诊断和持续症状可能提示感染性病因。与单一治疗相比，手术和药物治疗联合使用可优化治疗效果。: 上肢组织胞浆菌病的临床表现多种多样，包括腱鞘炎、骨髓炎、腕管综合征和腕关节脓肿。手术方法的选择可能取决于疾病的病因。提高对临床症状、体征和有效治疗方法的认识和了解，将有助于减少可能出现的并发症，如肌腱断裂和上肢功能障碍。
