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免疫功能正常患者发生的累及肺和肝的播散性组织胞浆菌病。

Disseminated Histoplasmosis With Lung and Liver Involvement in an Immunocompetent Patient.

作者信息

Marché Fernández Osvaldo Alexis, Pinto García Luis José, Hernández García Jesús Guillermo, Alonso Bello César Daniel, Díaz García Juan Daniel

机构信息

Internal Medicine, Hospital Juarez de Mexico, Mexico City, MEX.

Nephrology, Hospital Clinic Barcelona, Barcelona, ESP.

出版信息

Cureus. 2024 Dec 6;16(12):e75228. doi: 10.7759/cureus.75228. eCollection 2024 Dec.

Abstract

Histoplasmosis, caused by the fungus , is a significant public health concern in endemic regions like Mexico. Immunocompromised individuals, especially those with HIV infection and those exposed to nitrogen-rich environments, such as bird excrement or bat guano, are particularly vulnerable. This case report describes a middle-aged patient with jaundice in the skin and mucous membranes. Suspecting cholecystitis, abdominal imaging was performed, revealing hepatomegaly and bilateral pulmonary infiltrates with consolidations and nodular lesions on computed tomography. After being transferred to the internal medicine unit, a comprehensive diagnostic evaluation was carried out. Despite negative results from HIV serology and acid-fast bacillus testing, the patient tested positive for urine antigen, confirming the diagnosis of disseminated histoplasmosis. This case underscores the importance of considering histoplasmosis in the differential diagnosis of patients with relevant risk factors presenting with systemic symptoms.

摘要

由该真菌引起的组织胞浆菌病是墨西哥等流行地区的一个重大公共卫生问题。免疫功能低下的个体,尤其是感染艾滋病毒的个体以及暴露于富含氮的环境(如鸟粪或蝙蝠粪便)中的个体,特别容易感染。本病例报告描述了一名患有皮肤和粘膜黄疸的中年患者。怀疑患有胆囊炎,进行了腹部成像检查,计算机断层扫描显示肝脏肿大以及双侧肺部浸润并伴有实变和结节性病变。转入内科病房后,进行了全面的诊断评估。尽管艾滋病毒血清学和抗酸杆菌检测结果均为阴性,但该患者尿抗原检测呈阳性,确诊为播散性组织胞浆菌病。本病例强调了在对有相关危险因素且出现全身症状的患者进行鉴别诊断时考虑组织胞浆菌病的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa7e/11700511/d10030b5b554/cureus-0016-00000075228-i01.jpg

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