Benard G, Gryschek R C, Duarte A J, Shikanai-Yasuda M A
Immunogenetic and Experimental Transplantation Laboratory, Faculty of Medicine, Universidade de São Paulo, Brazil.
Mycopathologia. 1996;133(2):65-9. doi: 10.1007/BF00439115.
We describe the case reports of two patients with immunodeficiency secondary to paracoccidioidomycosis (PCM) and opportunistic Cryptococcus neoformans infections. Secondary immunodeficiency likely occurred as a consequence of the intestinal loss of proteins and lymphocytes associated with malabsorption syndrome due to obstructed lymphatic drainage. Both patients had had severe abdominal involvement during the acute PCM disease. Immunological evaluation showed cellular and humoral immunity impairment. Cryptococcosis manifested as relatively well circumscribed lesions: osteolytic lesions of the skull in one patient, and pulmonary nodules in the other. The latter was treated surgically and with amphotericin B, whereas the other was treated with the combination amphotericin-B and flucytosine. Both patients had a good response to treatment with complete regression of the lesions. They have now 2 and 4 years of follow-up with maintenance therapy and no indication of reactivation of the infection. PCM also did not reactivate. The clinical and immunological characteristics of these patients are discussed and compared to the opportunistic C. neoformans infections of AIDS and transplant patients.
我们报告了两例继发于副球孢子菌病（PCM）和机会性新型隐球菌感染的免疫缺陷患者的病例。继发免疫缺陷可能是由于淋巴管引流受阻导致吸收不良综合征，引起蛋白质和淋巴细胞在肠道丢失所致。两名患者在急性PCM疾病期间均有严重的腹部受累。免疫学评估显示细胞免疫和体液免疫受损。隐球菌病表现为边界相对清晰的病变：一名患者为颅骨溶骨性病变，另一名患者为肺结节。后者接受了手术治疗及两性霉素B治疗，而另一名患者接受了两性霉素B和氟胞嘧啶联合治疗。两名患者对治疗反应良好，病变完全消退。他们目前分别随访了2年和4年，接受维持治疗，且无感染复发迹象。PCM也未复发。本文讨论了这些患者的临床和免疫学特征，并与艾滋病患者和移植患者的机会性新型隐球菌感染进行了比较。
