Brinkman T K, Hubers A A M, van der Veek P P J, Scholten E M, Gelinck L B S
Haaglanden Medisch Centrum, locatie Westeinde, afd. Interne Geneeskunde/Maag-darm-lever, Den Haag.
Contact: T. K. Brinkman (
Ned Tijdschr Geneeskd. 2020 Nov 23;164:D4813.
Histoplasma capsulatum is an endemic fungus in especially tropical areas. While mostly asymptomatic, histoplasmosis can be life-threatening in immunocompromised patients.
A 60-year-old woman of Suriname origin, with a history of renal transplantation and use of mycophenolate mofetil and prednisone, presented with abdominal pain and diarrhea. Colonoscopy revealed ulcerative ileocolitis and biopsy showed active granulomatous inflammation. Morbus Crohn was considered the most plausible diagnosis after ruling out several infectious and pharmacological causes. Despite prednisone treatment, symptoms persisted and infliximab was initiated. The patient developed constitutional symptoms and radiological examination revealed disseminated granulomatous disease. Liver biopsy and re-evaluation of previous intestinal histopathology confirmed suspected histoplasmosis.
Histoplasmosis should be considered in immunocompromised patients with ileocolitis who have been in endemic regions (South America). Physicians need to assess the risk of previous exposure to histoplasmosis before starting anti-TNF-α therapy.
荚膜组织胞浆菌是一种地方性真菌，尤其在热带地区流行。虽然大多数情况下无症状，但组织胞浆菌病在免疫功能低下的患者中可能危及生命。
一名60岁的苏里南裔女性，有肾移植史，正在使用霉酚酸酯和泼尼松，出现腹痛和腹泻。结肠镜检查显示溃疡性回结肠炎症，活检显示有活动性肉芽肿性炎症。在排除了几种感染性和药物性病因后，克罗恩病被认为是最合理的诊断。尽管使用了泼尼松治疗，症状仍持续存在，于是开始使用英夫利昔单抗。患者出现全身症状，影像学检查显示播散性肉芽肿病。肝脏活检和对先前肠道组织病理学的重新评估证实了疑似组织胞浆菌病。
对于来自流行地区（南美洲）的免疫功能低下的回结肠炎症患者，应考虑组织胞浆菌病。医生在开始抗TNF-α治疗前需要评估既往接触组织胞浆菌病的风险。
