Falling down and following up.
Falling down and following up.
复制标题
DOI：
10.1016/s0140-6736(12)60645-x
复制
发表时间：
2012-09-08
期刊：
影响因子：
168.9
通讯作者：
Hu, Feng-Yu
中科院分区：
文献类型：
--
作者：
Wang, Charles;Cai, Wei-Ping;Tucker, Joseph D.;Li, Ling-Hua;Hu, Feng-Yu
2011年8月，一名38岁的男子在中国广东省清远市向当地医生提出全身疲劳。他发烧2周，干咳，体重减轻5 kg。他接受了3天的抗生素治疗，但发烧仍在继续。他在工作中晕倒了两次，倒在地上。他被同事送到当地医院。因为他承认曾与商业性工作者发生过无保护措施的性行为，所以做了艾滋病毒检测。HIV ELISA呈阳性，他去当地疾病控制和预防中心诊所进行了确认性蛋白质印迹。他继续夜间发烧，面部、躯干和背部出现病变。一周后，当Western blot检测结果呈阳性时，他被转诊到我们在广州的省艾滋病诊所。在检查中，我们的病人在面部、颈部、躯干和背部有几个1 - 3 mm的丘疹，在嘴唇上方有一个3 cm的坏死病灶（图A）。他的体温为40· 3 ℃，脉搏为每分钟104次，结膜苍白。无淋巴结肿大，呼吸系统检查正常。患者的CD 4细胞计数为10个细胞/μL，白色血细胞计数为5.46 × 10 - 15个细胞/L，红细胞压积为21%，血小板计数为26× 10 - 15个细胞/L。胸部X光片显示无浸润迹象。诊断为青霉菌病伴贫血性晕厥。开始2周静脉注射阿替霉素B脱氧胆酸盐治疗。25 ℃下在沙氏葡萄糖琼脂上的血培养物生长出真菌，其产生红色素并扩散到琼脂中。在骨髓活检样本的显微镜下观察到分离的雪茄状酵母（图B）。他出院后接受了伊曲康唑、复方新诺明和艾滋病毒抗逆转录病毒治疗（ART）。2012年2月末次随访时，他已恢复工作，无症状。
In August, 2011, a 38-year-old man presented to his local doctor in Qingyuan, Guangdong Province, China, with generalised fatigue. He had had fever for 2 weeks, a nonproductive cough, and a 5 kg weight loss. He was treated with antibiotics for 3 days, but the fever continued. He fainted twice at work, falling to the ground. He was taken to the local hospital by his coworkers. Because he admitted to having had unprotected sex with commercial sex workers, an HIV test was done. HIV ELISA was positive, and he went to the local Centre for Disease Control and Prevention clinic for a confirmatory Western blot. He continued to have nightly fevers and developed lesions on his face, trunk, and back. A week later, when the Western blot test result was returned positive, he was referred to our provincial HIV clinic in Guangzhou. On examination, our patient had several 1 to 3 mm erythematous papules on the face, neck, trunk, and back with a single 3 cm necrotic lesion above his lips (figure A). His temperature was 40· 3 C, and pulse rate was 104 beats per min. He had pale conjunctiva. There was no lymphadenopathy, and the respiratory examination was normal. He had a CD4 cell count of 10 cells per μL, white blood cell count of 5· 46× 10⁹ cells per L, haematocrit of 21%, and platelet count of 26× 10⁹ cells per L. Radio graph of the chest showed no evidence of infiltrates. A diagnosis of penicilliosis with syncope due to anaemia was made. Treatment with 2 weeks of intravenous amphotericin B deoxycholate was initiated. Blood cultures at 25 C on Sabouraud dextrose agar grew fungus that produced red pigment spreading into the agar. Septated cigar-shaped yeast was seen on microscopy of a bone marrow biopsy sample (figure B). He was dis charged with itraconazole, cotrimoxazole, and HIV antiretroviral therapy (ART). At last follow-up in February, 2012, he had resumed work and was asymptomatic.