慢性播散型组织胞浆菌病2例

 目的 提高临床医生对慢性播散性组织胞浆菌病的认识和诊治水平，以便减少误诊，改善预后。方法 根据北京协和医院1980年~2012年诊断慢性组织胞浆菌病的2例临床和随诊资料，结合文献对该病的临床表现、组织病理学特点、诊断、治疗及预后进行分析。结果 2例患者均病程较长、首发症状缺乏特异性，多系统受累，无特殊疾病史。其中1例有消化道、肺和双肾上腺受累，另1例为肺和腹膜受累。早期均被误诊，确诊均依靠组织病理，抗真菌治疗效果好，未见复发。结论 慢性组织胞浆菌病少见且临床表现不特异，确诊依赖于典型的病理形态和特殊染色，积极治疗预后好。

Two cases of chronic disseminated histoplasmosis

Objective To improve clinicians' awareness and the level of diagnosis and treatment of chronic disseminated histoplasmosis, in order to reduce misdiagnosis and improve the prognosis. Methods To make a literature review about the clinical manifestations, pathological features, diagnosis, treatment of chronic histoplasmosis,according to 2 cases of clinical and follow-up data in our hospital from 1980 to 2012.Results Both two cases of patients have a long course, with the first symptom lack of specific, multi-system involvement, who have no history of specific diseases. One case has gastrointestinal, lung and adrenal gland involvement, and the other one has lung and peritoneal involvement. Both of them are misdiagnosed early,with diagnosis by pathology and good effect by the anti-fungal therapy,neither relapsed. Conclusion Chronic histoplasmosis is rare and the clinical manifestations are not specific, diagnosis depends on the typical pathological morphology and special stains, prognosis is good with aggressive treatment.