Microbiología, Laboratorio Central-Hospital Alemán, Buenos Aires, Argentina.
Microbiología, Laboratorio Central-Hospital Alemán, Buenos Aires, Argentina.
Rev Argent Microbiol. 2022 Jul-Sep;54(3):209-214. doi: 10.1016/j.ram.2021.10.006. Epub 2021 Dec 18.
We report a case of disseminated histoplasmosis and COVID-19 infection in a renal transplant recipient in Argentina. The patient exhibited respiratory symptoms, and a chest computed tomography scan (CT) showed multiple bilateral centrilobular opacities with a tree-in-bud pattern in both lobes. The patient was initially treated as having bacterial community-acquired pneumonia, and then tuberculosis. A month later, histoplasmosis was diagnosed, and Histoplasma capsulatum LAmB clade was isolated from sputum, skin and oral lesions. The patient was hospitalized and treatment was started with intravenous liposomal amphotericin B. During the course of the antifungal therapy the respiratory symptoms worsened, a new chest CT showed a unilateral lesion with a ground glass appearance and SARS-CoV-2 was detected in a new nasopharyngeal sample. In addition, plasma therapy was administered, and the immunosuppressive regimen was adjusted (everolimus was interrupted, mycophenolate mofetil reduced, and meprednisone increased). Finally, the patient's progress was favorable and was discharged after five days on oral itraconazole treatment for histoplasmosis.
我们报告了一例在阿根廷的肾移植受者中发生的播散性组织胞浆菌病和 COVID-19 感染。该患者表现出呼吸道症状，胸部计算机断层扫描（CT）显示双侧多个小叶中心性混浊，呈树芽征。该患者最初被诊断为细菌性社区获得性肺炎，然后是肺结核。一个月后，诊断为组织胞浆菌病，从痰液、皮肤和口腔病变中分离出荚膜组织胞浆菌 LamB 枝。患者住院，并开始接受静脉注射两性霉素 B 脂质体治疗。在抗真菌治疗过程中，呼吸症状恶化，新的胸部 CT 显示单侧病变，呈磨玻璃样外观，新的鼻咽样本中检测到 SARS-CoV-2。此外，还进行了血浆治疗，并调整了免疫抑制方案（中断依维莫司，减少霉酚酸酯，增加泼尼松龙）。最后，患者的病情好转，在口服伊曲康唑治疗组织胞浆菌病五天后出院。
