Infectious Diseases, Creighton University, Omaha, Nebraska, USA.
Pulmonary, Critical Care and Sleep Medicine Department, Creighton University, Omaha, Nebraska, USA.
BMJ Case Rep. 2022 Mar 8;15(3):e248894. doi: 10.1136/bcr-2022-248894.
An immunocompetent man in his 20s came to the hospital for shortness of breath, fevers and lower back pain with unintentional 20 lbs. weight loss. Relevant history included a recent trip to Arizona 3 months prior to presentation. On arrival, he was noted to have decreased breath sounds bilaterally, and paraspinal tenderness in the lumbar area. CT scan revealed diffuse pneumonitis and an abscess with osteomyelitis in the sacrum and right iliac bone. Continued respiratory decompensation led him to the intensive care unit where he had a bronchoscopy and later sacroiliac joint fluid collection was performed. Based on his travel history, and elevated serum IgE, liposomal amphotericin B was initiated. Later his antibodies against resulted elevated and fungal cultures from the bronchoalveolar lavage and abscess from the sacral vertebrae grew mould, morphologically consistent with He was transitioned to oral fluconazole and will have a close follow-up outpatient.
一位 20 多岁免疫功能正常的男性因呼吸急促、发热和腰痛（伴有非故意的 20 磅体重减轻）到医院就诊。相关病史包括在出现症状前 3 个月最近一次前往亚利桑那州。入院时，他被发现双侧呼吸音减弱，腰部脊柱旁压痛。CT 扫描显示弥漫性肺炎和脓肿，伴有骶骨和右髂骨骨髓炎。持续的呼吸功能恶化导致他住进重症监护病房，在那里进行了支气管镜检查，随后进行了骶髂关节液采集。根据他的旅行史和血清 IgE 升高，开始使用脂质体两性霉素 B。后来，他对 的抗体升高，支气管肺泡灌洗液和骶骨脓肿的真菌培养长出霉菌，形态上与 一致。他转为口服氟康唑，并将在门诊进行密切随访。
