Banik Sudip Kumar, Sami Chowdhury Adnan, Khan Md Mizanur Rahman, Arafat Shohael Mahmud, Khan Abed Hussain
Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka; Bangladesh.
Department of Internal Medicine, Evercare Hospital Dhaka, Bangladesh.
Med Mycol Case Rep. 2024 Jul 8;45:100658. doi: 10.1016/j.mmcr.2024.100658. eCollection 2024 Sep.
A 19-year-old non-diabetic, non-HIV male presented with eighteen months of fever, weight loss, skin rash and lymphadenopathy. He was treated with anti-tubercular medication for more than twelve months in multiple institutions based on repeated biopsy reports of lymph nodes showing granuloma suggestive of tuberculosis. Before he was diagnosed at Bangabandhu Sheikh Mujib Medical University (BSMMU) with disseminated histoplasmosis at eighteen months of his disease, he already lost twenty kg weight, developed multiple small joint pain, back pain, and cough along with previously mentioned symptoms. Extensive investigations at BSMMU revealed biopsy material from multiple sites showed noncaseating granulomas with Periodic acid-Schiff (PAS) stain positive for budding oval yeast cells, and fungal culture revealed growth of dimorphic fungus suggestive of Histoplasma after three weeks. After treatment with intravenous liposomal amphotericin B with continuous itraconazole, the patient's fever completely subsided, his well-being improved, joint pain reduced, started to gain weight, and skin lesions started to heal. This case serves as a significant reminder that it is imperative to consider alternative diagnoses in patients who fail to show improvement with conventional antitubercular treatment.
一名19岁非糖尿病、非艾滋病毒感染男性，出现发热、体重减轻、皮疹和淋巴结病18个月。基于淋巴结反复活检报告显示肉芽肿提示结核病，他在多个机构接受了超过12个月的抗结核药物治疗。在疾病18个月时，他在孟加拉国谢赫穆吉布医科大学（BSMMU）被诊断为播散性组织胞浆菌病之前，已经体重减轻了20公斤，出现了多个小关节疼痛、背痛和咳嗽，以及上述症状。BSMMU的广泛检查显示，多个部位的活检材料显示非干酪样肉芽肿，高碘酸-希夫（PAS）染色显示出芽椭圆形酵母细胞呈阳性，真菌培养显示三周后生长出提示组织胞浆菌的双相真菌。在用静脉注射脂质体两性霉素B联合持续伊曲康唑治疗后，患者发热完全消退，健康状况改善，关节疼痛减轻，开始体重增加，皮肤病变开始愈合。该病例强烈提醒人们，对于接受传统抗结核治疗后未显示改善的患者，必须考虑其他诊断。
