累及免疫正常宿主肠道的播散型组织胞浆菌病3例

Intestinal Involvement in Disseminated Histoplasmosis:3 Cases of Immunocompetent Host

目的：探讨累及免疫正常宿主肠道的播散型组织胞浆菌病临床及内镜下特点、诊治及转归。方法对四川大学华西医院2005至2014年诊治的3例累及肠道的播散型组织胞浆菌病进行回顾性分析,总结患者的临床及内镜下特点、治疗及转归。结果临床表现无特异性,主要为发热、腹痛、腹胀等症状；肝脾肿大、浅表或深部淋巴结肿大等为常见体征。病程3~7月,确诊时间8~26d。3例均为免疫正常患者,累及结肠多部位及末段回肠,表现为弥漫或节段性的粘膜结节样隆起,伴或不伴糜烂、浅溃疡形成。所有患者均多部位活检、经病原学培养确诊。使用两性霉素B、伊曲康唑抗真菌治疗,2例痊愈,1例自动出院,失访。结论累及免疫正常宿主肠道的播散型组织胞浆菌病较少见,极易误诊漏诊,临床及内镜医师应重视内镜下病变表现特点,进行活检及病原学培养。

Objective To summarize the characteristics of intestinal lesions in 3 cases of immunocompetent host with dis-seminated histoplasmosis. Methods Retrospective analysis of clinical and endoscopic features was carried out in 3 cases of im-munocompetent host with disseminated histoplasmosis during 2005 and 2014 at our hospital. Results Fever,abdominal pain, dis-tention,hepatosplenomegaly,lymphadenopathy are the most common nonspecific symptoms and signs. Lesions which involving the colon and terminal ileum were manifested as diffuse or segmental mucosal nodular with or without erosion,shallow ulcers. The con-firmed diagnosis depended on multiple site biopsy and pathogenic culture. All patients were treated with amphotericin B deoxy-cholate and Itraconazole,it was effective in 2cases while the other one were lost to follow-up. Conclusion This rare disease is easy to be misdiagnosis. Gastrointestinal physicians should pay attention to the characteristics,biopsy and pathogen culture should be done if lesions had been found.