Department of Nursing, The Thrid Affiliated Hospital of Jinzhou Medical University, Liaoning Province, China.
Department of Clinical Laboratory, Affiliated Hospital of Engineering, University of Hebei, Handan, China.
Indian J Pathol Microbiol. 2021 Jan-Mar;64(1):192-194. doi: 10.4103/IJPM.IJPM_457_20.
Hemophagocytic lymphohistiocytosis (HLH) has been recognized as a potentially life-threatening syndrome. This is the first case of acquired HLH caused by dual infections with Candida albicans and reactivated EBV infections, which focuses on the importance of morphological awareness of peripheral blood and bone marrow because sometimes they are the only locations that HLH and fungal microorganisms can be diagnosed. A 29-year-old woman with a history of abdominal distension and 9 months of intermittent fevers ($38.8°C) was admitted to the hematology department with treatment for leukopenia and thrombocytopenia. Severe infection of bilateral pulmonary and marked hepatosplenomegaly were detected by computed tomography. EB virus-CA IgG, EB virus-NA IgG and EB virus-CA IgM were positive. Scattered yeast-like fungi were found on peripheral blood and bone marrow (BM) smears. BM smears indicated prominent hemophagocytosis. Cultures of bronchoalveolar lavage and BM confirmed the growth of C. albicans. A diagnosis of HLH caused by dual infections with Candida albicans and reactivated EBV infections was established based on the clinical features of the patient because 7 of the 8 diagnostic criteria were met. She was treated with etoposide, dexamethasone for HLH, as well as highly active antifungal and antiviral therapies for the underlying etiology of dual infections. The patient eventually recovered following the effective treatment. A timely and accurate diagnosis is crucial to the prognosis of the dangerous disease.
噬血细胞性淋巴组织细胞增生症（HLH）已被认为是一种潜在的危及生命的综合征。这是首例由白色念珠菌和再激活 EBV 感染双重感染引起的获得性 HLH，重点强调了对外周血和骨髓形态学认识的重要性，因为有时它们是唯一可以诊断 HLH 和真菌微生物的部位。一位 29 岁女性，因腹胀病史和 9 个月间歇性发热（$38.8°C$）就诊于血液科，当时正在接受白细胞减少症和血小板减少症的治疗。计算机断层扫描发现双侧肺部严重感染和明显的肝脾肿大。EB 病毒-CA IgG、EB 病毒-NA IgG 和 EB 病毒-CA IgM 阳性。外周血和骨髓（BM）涂片发现散在的酵母样真菌。BM 涂片提示明显的噬血现象。支气管肺泡灌洗液和 BM 的培养证实了白色念珠菌的生长。根据患者的临床特征，诊断为白色念珠菌和再激活 EBV 感染双重感染引起的 HLH，因为满足了 8 项诊断标准中的 7 项。她接受了依托泊苷、地塞米松治疗 HLH，以及针对双重感染基础病因的高活性抗真菌和抗病毒治疗。经过有效的治疗，患者最终康复。及时准确的诊断对这种危险疾病的预后至关重要。
