播散型组织胞浆菌病1例并文献复习  

A case of disseminated histoplasmosis and literature review

作　　者：曾婷婷 陈小龙 曹国强 ZENG Tingting;CHEN Xiaolong;CAO Guoqiang(Department of Respiratory and Critical Care Medicine,Army Characteristic Medical Center of PLA,Chongqing 400042,China)

机构地区：[1]陆军特色医学中心呼吸与危重症医学科,重庆400042

出　　处：《重庆医学》2021年第11期1896-1898,1904,共4页Chongqing medicine

摘　　要：目的提高临床医生对组织胞浆菌病的认识,减少该病漏诊、误诊。方法通过分析该院1例播散型组织胞浆菌病的诊疗经过,回顾性复习相关文献,总结该疾病的临床症状、病理组织学表现、诊断及鉴别诊断等特点。结果患者以发热,肝脾、淋巴结肿大,肝功能异常,血细胞减少为主要临床表现,先后被误诊为肺部感染、肺结核、淋巴瘤,行组织病理活检及骨髓细胞学检查,均未识别出特殊病原体感染,抗生素及抗结核治疗无效,诊断不明确出院。患者于外院再次进行骨髓细胞学检查,确诊为播散型组织胞浆菌病,予以两性霉素B、伏立康唑抗真菌治疗后好转,随访半年未复发。结论组织胞浆菌病在临床罕见,容易误诊,必要时应多次行组织病理学活检或骨髓穿刺活检检查协助诊断。Objective To increase the clinicians′cognition on histoplasmosis for reducing the missed diagnosis and misdiagnosis.Methods The related literatures were retrospectively reviewed and the characteristics of clinical symptoms,histopathologic manifestations,diagnosis and differential diagnosis were summarized by analyzing a case of disseminated histoplasmosis.Results The patient′s main clinical manifestations were fever,lymphadenopathy,hepatomegaly,splenomegaly,liver function abnormality and pancytopenia,and was successively misdiagnosed as pulmonary infection,pulmonary tuberculosis and lymphoma.The histopathological examination and bone marrow cytologic examination did not recognize the specific pathogen infection,the antibiotic and anti-tuberculosis treatment was ineffective,and the patient was discharged without definite diagnosis.The patient was diagnosed as disseminated histoplasmosis by bone marrow cytological examination again in another hospital.After antifungal treatment of amphotericin B and voriconazole,the patient was improved and had no recurrence for half a year follow up.Conclusion Histoplasmosis is rare in clinic and easy to be misdiagnosed,it is necessary to conduct the repeated histopathological biopsies or bone marrow aspiration biopsy for assisting in diagnosis.

关 键 词：播散型组织胞浆菌病 结核 误诊 

分 类 号：R446.8[医药卫生—诊断学]