A novel case of disseminated blastomycosis in China  

作　　者：Meng-Jiao Fu Hua Zhou Wen-Jiang Ma Qing Yang Bao-Lang Leng Xuan-Li Xu 

机构地区：[1]Respiratory Department,The First Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou,Zhejiang 310002,China [2]Laboratory Department,The First Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou,Zhejiang 310002,China [3]Respiratory Department,Hangzhou Third Hospital,Hangzhou,Zhejiang 310009,China

出　　处：《Chinese Medical Journal》2019年第24期3006-3008,共3页中华医学杂志（英文版）

摘　　要：To the Editor:A 25-year-old male patient was admitted to the First Affiliated Hospital,School of Medicine,Zhejiang University with complaints of fever,cough,and knee pain.He was an overseas student and had been back from the USA for 3 weeks,with no remarkable medical history before admission.He was initially diagnosed with a cold and given non-steroidal anti-inflammatory analgesics and oral antibiotics in a clinic.However,his symptoms were not alleviated.Swelling and pain in his left knee became worse so that normal walking was not possible.Gradually a red rash with mild pain above the epidermis appeared in the lower limbs.Then,the patient presented to a municipal hospital in Hangzhou,China,and underwent a chest computed tomography(CT)scan,which revealed highdensity areas in both the left lower lobe[Figure 1A]and left hilum[Figure 1B].Laboratory tests indicated the following results:white blood cell(WBC)count 11.6×10^9/L,neutrophils 88.2%,and C-reaction protein(CRP)70.3 mg/dL.Community-acquired pneumonia was considered first,and empirical anti-bacterial treatment(moxifloxacin injection,400 mg per day)was administered.The patient did not improve despite the use of moxifloxacin injections for 1 week but did have an elevation in liver enzymes(alanine transaminase[ALT]191 U/L and aspartic transaminase[AST]121 U/L),higher WBC count(16.6×10^9/L)and higher CRP(213 mg/dL).His left knee joint swelling progressed,and the pain worsened.A magnetic resonance imaging scan of his left knee revealed edema of the bone marrow in the distal femur as well as joint effusion[Figure 1C].Meanwhile,the skin lesions increased in number and became larger,and some of the lesions ruptured and discharged pus[Figure 1D].Bronchoscopy results revealed a neoplasm in the left lingular bronchus(B4+B5),and tissue biopsy reported suspicious spore-like substances.Because of the difficulty of diagnosis,the patient was transferred to the Respiratory Department,First Affiliated Hospital,School of Medicine,Zhejiang University on May 28th,2018.On admissi

关 键 词：admitted FIGURE SWELLING 

分 类 号：R73[医药卫生—肿瘤]