Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA.
BMJ Case Rep. 2024 Aug 19;17(8):e259484. doi: 10.1136/bcr-2023-259484.
A male in his 30s who was recently diagnosed with HIV arrived at the emergency department exhibiting an altered mental state and acute respiratory distress. Initial laboratory tests revealed a high anion gap metabolic acidosis, elevated liver enzyme levels and bicytopenia. A CT scan identified a miliary pattern. Bronchoscopy with bronchoalveolar lavage displayed epithelial and inflammatory cells. However, subsequent tests ruled out the presence of fungi, Pneumocystis organisms, malignancies, granulomas and viral inclusions. Broad-spectrum antibiotics with emphasis on and antifungal treatments were administered. The regimen was adjusted after a positive urine test for the Histoplasma antigen.The patient later manifested signs and symptoms, including increased ferritin level, fever, splenomegaly, diminished natural killer cell function and heightened interleukin-2 receptor levels, confirming haemophagocytic lymphohistiocytosis. Given the patient's gravely decompensated state, the treatment incorporated dexamethasone, and the patient's vasopressor-resistant septic shock was addressed with methylene blue.
一位 30 多岁的男性最近被诊断出 HIV 感染，他因精神状态改变和急性呼吸窘迫而到急诊就诊。初步实验室检查显示高阴离子间隙代谢性酸中毒、肝酶水平升高和两系血细胞减少。CT 扫描显示为粟粒样模式。支气管镜检查和肺泡灌洗显示上皮细胞和炎症细胞。然而，随后的检查排除了真菌、卡氏肺孢子虫、恶性肿瘤、肉芽肿和病毒包涵体的存在。给予了广谱抗生素，重点是抗真菌治疗。在尿中检测到组织胞浆菌抗原阳性后，调整了治疗方案。患者后来出现了一些迹象和症状，包括铁蛋白水平升高、发热、脾肿大、自然杀伤细胞功能下降和白细胞介素-2 受体水平升高，这些都证实了噬血细胞性淋巴组织细胞增生症。鉴于患者病情严重失代偿，治疗中加入了地塞米松，并使用亚甲蓝治疗患者的升压素抵抗性感染性休克。
