Walker J V, Baran D, Yakub N, Freeman R B
JAMA. 1977 Mar 28;237(13):1350-2.
A 56-year-old man with a three-month history of fever, malaise, anorexia, mental confusion, and weight loss had hypercalcemia and azotemia. The chest roentgenogram was normal. Biopsy material removed 2 1/2 years previously showed noncaseating granulomas. Sarcoidosis was diagnosed, and prednisone was administered. Fever persisted, and the patient died 49 days after admission. Postmortem examination showed evidence of extensive disseminated histoplasmosis, interstitial nephritis, and papillary necrosis. This communication emphasizes the difficulty in diagnosing the etiology of disseminated, noncaseating granulomatous disease.
一名56岁男性，有3个月发热、乏力、厌食、精神错乱及体重减轻病史，伴有高钙血症和氮质血症。胸部X线片正常。2年半前切除的活检材料显示为非干酪样肉芽肿。诊断为结节病，并给予泼尼松治疗。发热持续存在，患者入院49天后死亡。尸检显示有播散性组织胞浆菌病、间质性肾炎和乳头坏死。本文强调了诊断播散性非干酪样肉芽肿性疾病病因的困难。
