Boehm D, Lynch J M, Hodges G R, Abdou N I, Garrison R G, Lee S H, Bellome J, Barnes W G
Am J Med Sci. 1982 Mar-Apr;283(2):71-8. doi: 10.1097/00000441-198203000-00004.
A 50-year-old black man with constitutional symptoms, cutaneous nodules, and bilateral hilar adenopathy was found to have non-caseating granulomata on bronchial biopsy. He was treated with corticosteroids for sarcoidosis. Within five months he was found to have disseminated sporotrichosis. Electron microscopy revealed mycelial forms of S. schenckii in superficial lesions and yeast forms from deep tissue sites: no novel forms were seen. Blood mononuclear cell studies revealed hyperactive suppressor cells with respect to non-specific T cell targets and the antigen specific target. Examination of the initial biopsy material after digestion with diastase before PAS staining revealed budding yeast consistent with S. schenckii. This case emphasizes the need for careful histopathologic examination of clinical material before a diagnosis of sarcoidosis is made, and reveals an immunologic abnormality which may account for the patient's anergic state and susceptibility to S. schenckii infection.
一名50岁的黑人男性，有全身症状、皮肤结节和双侧肺门淋巴结肿大，支气管活检发现非干酪样肉芽肿。他因结节病接受了皮质类固醇治疗。五个月内，他被发现患有播散性孢子丝菌病。电子显微镜检查显示，浅表病变中有申克孢子丝菌的菌丝形式，深部组织部位有酵母形式：未发现新的形式。血液单核细胞研究显示，相对于非特异性T细胞靶点和抗原特异性靶点，抑制细胞活性过高。在PAS染色前用淀粉酶消化初始活检材料后进行检查，发现与申克孢子丝菌一致的出芽酵母。该病例强调了在诊断结节病之前对临床材料进行仔细组织病理学检查的必要性，并揭示了一种免疫异常，这可能解释了患者的无反应状态和对申克孢子丝菌感染的易感性。
