以胆道梗阻伴胆管炎为首发表现的播散性隐球菌病1例  

One case of disseminated cryptococcosis initially characterized by obstruction of biliary tract and cholangitis

作　　者：许振宇[1] 李沛真 许允[1] 熊力[2] 舒怡[3] 杨敏[4] 王小伟 张旻[1] 周宁 XU Zhen-yu;LI Pei-zhen;XU Yun;XIONG Li;SHU Yi;YANG Min;WANG Xiao-wei;ZHANG Min;ZHOU Ning(Department of Infectious Diseases,The Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Hepatobiliary and Pancreatic Surgery,The Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Neurology,The Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Pulmonary and Critical Care Medicine,The Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Pathology,The Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院感染科,湖南长沙410011 [2]中南大学湘雅二医院胆胰外科,湖南长沙410011 [3]中南大学湘雅二医院神经内科,湖南长沙410011 [4]中南大学湘雅二医院呼吸危重症医学科,湖南长沙410011 [5]中南大学湘雅二医院病理科,湖南长沙410011

出　　处：《中国感染控制杂志》2023年第7期828-838,共11页Chinese Journal of Infection Control

摘　　要：播散性隐球菌病主要是由隐球菌引起的全身不连续的两个及以上部位感染的疾病,其临床表现多样,常诊断困难。某院收治1例因“腹胀、间断低热2个月,身目黄染1个月,高热伴头痛11 d”入院的34岁女性患者,该患者无免疫力低下情况,病程中患者最先表现为腹胀、身目黄染、间断低热,继而出现高热、头痛,辅助检查发现胆管壁增厚并胆道梗阻,肺部渗出性病变,心内膜赘生物,纵膈、肝门、腹膜后多发淋巴结肿大,腰穿脑脊液压力>400 mmH2O,脑脊液感染病原体宏基因组二代测序及培养均发现新生隐球菌,腹膜后淋巴结及肝脏病理检查均提示隐球菌感染,患者最终诊断为播散性隐球菌病。本文就该例病例进行分析,旨在提高临床对播散性隐球菌感染的认识。Disseminated cryptococcosis is a disease caused by Cryptococcus spp.that affects two or more non-adjacent body parts.The clinical manifestations of the disease are diverse,often leading to diagnostic challenges.A 34-year-old female patient was admitted to a hospital due to abdominal distension,intermittent low fever for 2 months,jaundice for 1 month,and high fever with headache for 11 days.The patient was not immunocompromised.During the disease course,the patient initially presented with abdominal distension,jaundice,and intermittent low fever,followed by high fever and headache.Auxiliary examination revealed thickened bile duct walls and biliary obstruction,pulmonary exudative lesions,endocardium vegetations,multi-lymph node enlargement in mediastinum,hepatic hilum and retroperitoneal space,cerebrospinal fluid pressure>400 mmH 2O on lumbar punctures.Meta-genomic next-generation sequencing(mNGS)and culture of cerebrospinal fluid detected Cryptococcus neoformans.Pathological examination of retroperitoneal lymph nodes and liver suggested Cryptococcus infection.The patient was ultimately diagnosed with disseminated cryptococcosis.The case analysis aims to enhance clinical understanding on disseminated cryptococcal infection.

关 键 词：播散性隐球菌病 胆道隐球菌病 机会性感染 宏基因组二代测序 

分 类 号：R519.4[医药卫生—内科学] R575.7[医药卫生—临床医学]