Ukarapol N, Sirisanthana V, Wongsawasdi L
Gastrointestinal Unit, Faculty of Medicine, Chiang Mai University, Thailand.
J Med Assoc Thai. 1998 Aug;81(8):637-40.
Disseminated P. marneffei infection is one of the common opportunistic infections seen in HIV-infected patients in Southeast Asia. We report 3 cases of HIV-infected children with mesenteric lymphadenitis presented with prolonged fever and abdominal pain. The first two patients were diagnosed as peritonitis and acute appendicitis prior to exploratory laparotomy. Operative findings revealed multiple enlarged mesenteric lymph nodes. Histopathologic findings of mesenteric lymph nodes biopsy were characteristic for P. marneffei infection. Mesenteric lymphadenitis in the last patient was diagnosed by abdominal ultrasound. All three cases had positive blood and bone marrow cultures for P. marneffei. These patients were treated with amphotericin B. Fever declined in 3-6 days. The first two patients survived but the last one subsequently died from underlying hemophilia A (GI bleeding).
Acute mesenteric lymphadenitis can be one of the unusual manifestations caused by P. marneffei. Southeast Asia is an endemic area for P. marneffei and is severely affected by acquired immunodeficiency syndrome epidemic. Therefore, mesenteric lymphadenitis should be considered in HIV-infected persons who present with prolonged fever and abdominal pain.
播散性马尔尼菲青霉感染是东南亚地区艾滋病毒感染患者常见的机会性感染之一。我们报告3例感染艾滋病毒的儿童，他们患有肠系膜淋巴结炎，表现为长期发热和腹痛。前两名患者在剖腹探查术前被诊断为腹膜炎和急性阑尾炎。手术结果显示多个肠系膜淋巴结肿大。肠系膜淋巴结活检的组织病理学结果具有马尔尼菲青霉感染的特征。最后一名患者的肠系膜淋巴结炎通过腹部超声诊断。所有3例患者的血液和骨髓培养马尔尼菲青霉均呈阳性。这些患者接受了两性霉素B治疗。发热在3至6天内消退。前两名患者存活，但最后一名患者随后死于潜在的甲型血友病（胃肠道出血）。
急性肠系膜淋巴结炎可能是马尔尼菲青霉引起的不寻常表现之一。东南亚是马尔尼菲青霉的流行地区，并且受到获得性免疫缺陷综合征流行的严重影响。因此，对于出现长期发热和腹痛的艾滋病毒感染者，应考虑肠系膜淋巴结炎。
