Nichols Larry, Rowley Lindsey, Lall Ashley
Mercer University School of Medicine, Department of Pathology. Macon, GA, USA.
Mercer University School of Medicine. Macon, GA, USA.
Autops Case Rep. 2020 Jun 5;10(3):e2020180. doi: 10.4322/acr.2020.180.
Hepatic cirrhosis, diabetes mellitus and iron overload can each independently predispose to cryptococcosis. Hereditary hemochromatosis leads to all three of these predispositions. This report is the case of a patient with chronic hepatitis B virus infection and cirrhosis, who had markedly elevated serum ferritin and 99% transferrin saturation, and developed a leukemoid reaction. Autopsy revealed disseminated cryptococcosis for which the leukemoid reaction was a clue and possible hereditary hemochromatosis of which elevated ferritin and transferrin saturation can be clues. Hereditary hemochromatosis is an important diagnosis clinicians should never miss because early treatment with phlebotomy can be life-saving. Disseminated cryptococcosis can be rapidly diagnosed with serum cryptococcal antigen test and is treatable.
肝硬化、糖尿病和铁过载各自都可独立导致隐球菌病易感性增加。遗传性血色素沉着症会导致所有这三种易感性增加。本报告介绍了一名慢性乙型肝炎病毒感染和肝硬化患者，其血清铁蛋白显著升高，转铁蛋白饱和度达99%，并出现类白血病反应。尸检发现播散性隐球菌病，其中类白血病反应是一条线索，而血清铁蛋白升高和转铁蛋白饱和度升高可能提示存在遗传性血色素沉着症。遗传性血色素沉着症是临床医生绝不能漏诊的重要疾病，因为早期放血治疗可能挽救生命。血清隐球菌抗原检测可快速诊断播散性隐球菌病，且该病可治疗。
