肾移植患者播散性隐球菌病致广泛皮下结节1例

Disseminated cryptococcosis with extensive subcutaneous nodules in renal transplant recipient :A case report

患者女性34岁,行肾移植术后6年,一直使用免疫抑制剂治疗。不明原因发热7天入院。体检:体温38℃,患者背部皮肤广泛3cm至6cm大小不等皮下结节,表面皮肤未见破损,呈红色、偏硬、有压痛。皮肤组织活检见深达真皮层急性肉芽肿性炎,炎症组织中弥漫酵母样细胞。经培养鉴定并查血、脑脊液培养鉴定均可见新生隐球菌生长,诊断为播散性隐球菌病。予氟康唑200mg每日静脉滴注治疗。患者体温消退,皮疹也逐步消退。

A 34-year-old woman with a 6-year-old adequately functioning cadaveric renal allograft for nephrosis was hospitalized with a 7-day history of low-grade fever.She was receiving maintenance immunosuppressive therapy.Initial physic al examination disclosed a well-developed woman in no distress.Her vital signs were normal except f or an oral temperature of 38℃.Her back was involved by several areas(6by 3cm)of subcutaneous nodules,with red color,induration,and tenderness.The overlying skin was intact.Histolo gic examination of the skin biopsy specimen disclosed acute granulomatous i nflammation of the subcutaneous tis sue with extension into the overlying dermis.The yeastlike cells spread throughout the areas of inf lammation.All studies of the cerebr ospinal fluid and blood were positive.It was consistent with the diagnosis of disseminated cryptoco ccosis.Fluconazole was administered at 200mg /d intravenously.The patient ' s situation was improved.