马尔尼菲篮状菌感染继发噬血细胞综合征1例文献报道  

A case report of hemophagocytic syndrome secondary to talaromyces marneffei infection

作　　者：江子晴 曾彦平[1,2] 纪晓栋[2] 左俊岭[2] JIANG Ziqing;ZENG Yanping;JI Xiaodong;ZUO Junling(The First Clinical College,Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China;Emergency Department,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China)

机构地区：[1]广州中医药大学第一临床医学院,广东广州510405 [2]广州中医药大学第一附属医院急诊科,广东广州510405

出　　处：《山东大学学报（医学版）》2022年第8期91-97,114,共8页Journal of Shandong University:Health Sciences

基　　金：广东省医学科学技术研究基金(B2021345)

摘　　要：目的对1例临床确诊马尔尼菲篮状菌(TM)感染继发噬血细胞综合征(HPS)患者的诊疗思路进行分析,以期提高临床医生对该病的认识。方法收集我院1例TM感染继发HPS患者的临床及实验室资料进行分析,并复习相关文献,对疾病诊疗思路进行总结。结果患者,男,53岁,无恶性肿瘤及免疫缺陷病史,出现持续性发热、咳嗽咯痰、皮疹、黄疸、肝脾大、肝功能损害、血红蛋白及血小板下降,炎症指标、甘油三酯、铁蛋白升高,痰真菌培养、外周血宏基因新一代测序找到TM,骨髓涂片找到噬血细胞,诊断为TM感染继发HPS,予伏立康唑抗真菌,人免疫球蛋白冲击联合糖皮质激素治疗。结论TM感染临床表现无特异性,诊断困难,同时继发HPS者病情危重,治疗难度大,需根据患者情况酌情调整治疗方案。Objective To analyze the diagnosis and treatment of a patient with hemophagocytic syndrome(HPS)secondary to talaromyces marneffei(TM)infection,in order to improve clinician's understanding of the disease.Methods Clinical and laboratory data of a patient with HPS secondary to TM infection were collected and analyzed,and relevant literature was reviewed to summarize the diagnosis and treatment of the disease.Results The patient,a 53-year-old man,with no history of malignant tumor or immune deficiency,presented with persistent fever,cough,expectoration,rashes,jaundice,hepatomegaly,splenomegaly,liver function impairment,decrease of hemoglobin and platelets,and increase of inflammation indicators,triglycerides and ferritin.TM was detected with sputum culture and metagenomic next-generation sequencing of peripheral blood.Macrophages were observed with bone marrow smear.After HPS secondary to TM infection was confirmed,the patient was treated with voriconazole and human immunoglobulin combined with glucocorticoid.Conclusion The clinical manifestations of TM infection are non-specific and the disease is difficult to diagnose.HPS secondary to TM infection increases the difficulty of treatment.Treatment should be tailored according to the condition of patients.

关 键 词：马尔尼菲篮状菌 噬血细胞综合征 宏基因组新一代测序 

分 类 号：R519[医药卫生—内科学] R55[医药卫生—临床医学]