Pulmonary histoplasmosis presenting as chronic productive cough, fever, and massive unilateral consolidation in a 15-year-old immune-competent boy: a case report.
Pulmonary histoplasmosis presenting as chronic productive cough, fever, and massive unilateral consolidation in a 15-year-old immune-competent boy: a case report.
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DOI：
10.1186/1752-1947-5-374
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发表时间：
2011-08-15
影响因子：
1
通讯作者：
Peck, Robert N
中科院分区：
文献类型：
--
作者：
Kabangila, Rodrick;Semvua, Kilonzo;Peck, Robert N
简介：在组织胞浆菌病流行地区，严重组织胞浆菌病是影响CD 4细胞计数非常低的患者的艾滋病定义机会性感染之一。荚膜组织胞浆菌变种杜布氏病在西非和中非很常见，在那里它发生在艾滋病毒/艾滋病和非艾滋病毒患者中。几例危及生命的组织胞浆菌病的免疫功能正常的个人已被报道worldwide.CASE REPORT：我们描述了一个肺组织胞浆菌病的尸检和组织学调查的基础上诊断的情况。一名15岁的东非免疫功能正常的男孩，有痰涂片阳性肺结核病史和两年的岩石切割史，因慢性排痰性咳嗽、发热和大量单侧实变来我院就诊。在我院就诊时，该患者因复发性肺结核进行经验性治疗，但未成功，并于入院后第7天死亡。尸检发现一个巨大的肉芽肿性病变伴干酪样变，但几种Ziehl-Neelsen染色均未检测到抗酸杆菌。然而，高碘酸-希夫染色是积极的，组织学检查发现的功能提示组织胞浆菌酵母celles.CONCLUSION：严重的肺组织胞浆菌病应考虑在评估免疫功能正常的患者的疾病的危险因素，目前与肺部症状模仿结核病。
INTRODUCTION: Severe histoplasmosis is known to be among the AIDS-defining opportunistic infections affecting patients with very low CD4 cell counts in histoplasmosis-endemic areas. Histoplasma capsulatum var. duboisii is common in West and Central Africa, where it occurs in both HIV/AIDS and non-HIV patients. Few cases of life-threatening histoplasmosis in immune-competent individuals have been reported worldwide.CASE REPORT: We describe a case of pulmonary histoplasmosis diagnosed on the basis of autopsy and histological investigations. A 15-year old East African immune-competent boy with a history of smear-positive tuberculosis and a two-year history of rock cutting presented to our hospital with chronic productive cough, fever, and massive unilateral consolidation. At the time of presentation to our hospital, this patient was empirically treated for recurrent tuberculosis without success, and he died on the seventh day after admission. The autopsy revealed a huge granulomatous lesion with caseation, but no acid-fast bacilli were detected on several Ziehl-Neelsen stains. However, periodic acid-Schiff staining was positive, and the histological examination revealed features suggestive of Histoplasma yeast cells.CONCLUSION: Severe pulmonary histoplasmosis should be considered in evaluating immune-competent patients with risk factors for the disease who present with pulmonary symptoms mimicking tuberculosis.