Meister P, Segerer W, Segerer S, Auer K
Institut für Pathologie, Städtisches Krankenhaus, München-Harlaching.
Pathologe. 1995 Nov;16(6):434-8. doi: 10.1007/s002920050127.
A girl aged 14 years, 8 months presented with painful swelling of cervical lymph nodes. On frozen section malignancy could be ruled out. There were nonspecific inflammatory changes. In the presence of a prominent eosinophilic reaction the possibility of a drug reaction had been suggested. Because of decreasing renal function, dialysis was started 1 day after lymph node extirpation. A renal biopsy revealed acute interstitial nephritis-again with eosinophils. At this point parasitosis was discussed. There was a slightly elevated titer for filariasis. Shortly thereafter, also eggs of Ascaris lumbricoides were found in the feces. A pulmonary infiltrate made its appearance, with eosinophils in the pleural fluid. About 20 days later, after dialysis and anti-Ascaris therapy, the patient was discharged with no further complaints. Repeated controls revealed no further complaints, especially no more Ascaris lumbricoides. This case had two special aspects: (1) initial presentation with painful cervical lymph node swelling, and (2) subsequent acute renal failure. The literature revealed only four patients with Ascaris lumbricoides infection and acute interstitial nephritis, all described by one author (Zollinger). Perhaps a special hyperergic situation in this patient was responsible for the renal involvement; however, this complication should be watched for in all cases Ascaris lumbricoides infections.
一名14岁8个月的女孩因颈部淋巴结疼痛性肿胀就诊。冰冻切片检查排除了恶性肿瘤。存在非特异性炎症改变。鉴于有明显的嗜酸性粒细胞反应，曾怀疑是药物反应。由于肾功能下降，在淋巴结切除术后1天开始进行透析。肾活检显示为急性间质性肾炎，同样伴有嗜酸性粒细胞。此时讨论了寄生虫病的可能性。丝虫病滴度略有升高。此后不久，粪便中也发现了蛔虫卵。出现了肺部浸润，胸腔积液中有嗜酸性粒细胞。大约20天后，经过透析和抗蛔虫治疗，患者出院，无进一步不适。多次复查未发现进一步不适，尤其是没有蛔虫了。该病例有两个特殊之处：（1）最初表现为颈部淋巴结疼痛性肿胀，（2）随后出现急性肾衰竭。文献中仅报道了4例蛔虫感染并发急性间质性肾炎的患者，均由同一作者（佐林格）描述。也许该患者特殊的高敏状态导致了肾脏受累；然而，在所有蛔虫感染病例中都应警惕这种并发症。
