Hood A B, Inglis F G, Lowenstein L, Dossetor J B, MacLean L D
Can Med Assoc J. 1965 Sep 11;93(11):587-92.
Two patients with disseminated histoplasmosis are reported. One patient presented with severe thrombocytopenic purpura and splenomegaly. Histoplasmin skin test, blood and bone marrow cultures and smears, sputum cultures, and chest radiographs were negative for Histoplasma capsulatum. She died on the sixth hospital day from a massive intracerebral hemorrhage. Cardiorespiratory function was maintained until one kidney was removed for homotransplantation. The second patient, with chronic glomerulonephritis and uremia, received the renal homograft from the first patient. Initial signs of homograft rejection developed five days postoperatively. Diffuse thrombocytopenic purpura occurred shortly thereafter. Spores of Histoplasma capsulatum were observed in blood smears, in leukocyte concentrates, and in five-day leukocyte cultures from the blood obtained prior to death. Disseminated histoplasmosis was found in both patients at autopsy. The severe platelet deficit in both cases suggests that systemic histoplasmosis should be considered as a cause of thrombocytopenic purpura.To our knowledge, this is the first reported instance of direct transmission of Histoplasma capsulatum, and must be considered a hazard in homotransplantation.In vitro leukocyte cultures as a method for early diagnosis of certain disseminated fungous infections needs further investigation.
报告了两名播散性组织胞浆菌病患者。一名患者表现为严重血小板减少性紫癜和脾肿大。组织胞浆菌素皮肤试验、血液和骨髓培养及涂片、痰培养和胸部X线片均未发现荚膜组织胞浆菌。她于住院第六天死于大量脑出血。在一个肾脏被摘除用于同种移植之前，心肺功能一直维持正常。第二名患者患有慢性肾小球肾炎和尿毒症，接受了第一名患者的同种肾移植。术后五天出现同种移植排斥的最初迹象。此后不久发生了弥漫性血小板减少性紫癜。在血涂片、白细胞浓缩物以及死亡前采集的血液的五天白细胞培养物中均观察到荚膜组织胞浆菌的孢子。尸检发现两名患者均有播散性组织胞浆菌病。两例患者严重的血小板缺乏提示系统性组织胞浆菌病应被视为血小板减少性紫癜的一个病因。据我们所知，这是首例报告的荚膜组织胞浆菌直接传播的病例，在同种移植中必须被视为一种危险因素。作为某些播散性真菌感染早期诊断方法的体外白细胞培养需要进一步研究。
