播散型组织胞浆菌病二例误诊分析

Misdiagnosis Analysis of 2 Patients with Disseminated Histoplasmosis

目的提高对播散型组织胞浆菌病(disseminated histoplasmosis,DHP)的认识,以减少误诊。方法对我院2例DHP误诊病例的诊疗过程进行回顾性分析,并复习相关文献。结果本文2例主要表现为反复高热、进行性消瘦,肝、脾及淋巴结增大,血细胞不同程度减少、肝功能异常,先后误诊为肺结核、恶性淋巴瘤、肺炎支原体肺炎,予多种抗生素治疗无效。最终行骨髓细胞学检查发现荚膜组织胞浆菌,确诊为DHP。予伊曲康唑、两性霉素B抗真菌治疗病情好转,随访无复发。结论 DHP临床表现无特异性,诊断困难,常误诊,提示临床遇及一般抗生素治疗无效的发热、多脏器功能受损患者需警惕本病,积极多次行血液、骨髓、痰涂片等病原学检查,有助于正确诊断。

Objective To improve awareness of disseminated histoplasmosis （DHP） in order to avoid misdiagnosis. Methods Clinical data of 2 patients with disseminated histoplasmosis was retrospectively analyzed, and related literature was also reviewed. Results The 2 patients＇main manifestations were repeated hyperpyrexia, progressive emaciation, enlargements of liver, spleen and lymphnodes, hypocytosis at different degrees and liver dysfunction. The 2 patients were misdiagnosed as having pulmonary tuberculosis, malignant lymphoma, myeoplasma pneumonia, and different antibiotics treatments were tried but failed. Finally the 2 patients were confirmed as having DHP by histoplasma capsulatum detected in microscopic examination of bone marrow cytology. Anti-fungal treatments with Itraconazole and amphotericin B were applied, and there was no recurrence at follow-up. Conclusion Clinical manifestations of PDH are nonspecific, so it is difficult to diagnose the disease. We should suspect DHP when patients suffer repeated fevers and muhi-organs disfunetion, if the condition worsens after general antibiotic therapy, and repeated pathogenic examinations of blood, bone marrow and sputum are helpful in accurate diagnosis.