Department of Pulmonary Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, Fujian, China.
Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
J Infect Dev Ctries. 2022 Mar 31;16(3):570-574. doi: 10.3855/jidc.15297.
Histoplasmosis is an infection caused by the dimorphic fungus Histoplasma capsulatum. The lungs are the most common site of infection, especially in patients with immune deficiency. We report a case of 62-year-old male patient presented with cough for 3 months and had been taking immunosuppressive drugs for 10 years after heart transplantation. Chest CT scan showed multiple pulmonary nodules. Lung tissue biopsy specimen culture suggested fungal infection, and Histoplasma capsulatum was confirmed by next-generation sequencing (NGS) detection. The patient was diagnosed with pulmonary histoplasmosis. After administration of voriconazole for 46 days, the symptom of cough was markedly relieved and the lesions were partly absorbed. After 13 months of treatment, the lesions completely disappeared, and no significant side-effect of voriconazole was observed. To our knowledge, report of voriconazole as the treatment of histoplasmosis is rare, especially in non-endemic areas. Moreover, this case enriches our experience in the adjustment between immunosuppressive and antifungal agents in treating histoplasmosis.
组织胞浆菌病是由二相真菌荚膜组织胞浆菌引起的感染。肺部是最常见的感染部位，尤其是在免疫功能低下的患者中。我们报告了一例 62 岁男性患者，因咳嗽 3 个月就诊，在心脏移植后已服用免疫抑制剂 10 年。胸部 CT 扫描显示多个肺结节。肺组织活检标本培养提示真菌感染，通过下一代测序（NGS）检测证实为荚膜组织胞浆菌。患者被诊断为肺组织胞浆菌病。给予伏立康唑治疗 46 天后，咳嗽症状明显缓解，病变部分吸收。治疗 13 个月后，病变完全消失，未观察到伏立康唑的明显不良反应。据我们所知，伏立康唑治疗组织胞浆菌病的报道很少，尤其是在非流行地区。此外，该病例丰富了我们在治疗组织胞浆菌病时调整免疫抑制剂和抗真菌药物的经验。
