特殊部位新型隐球菌感染1例并文献复习

目的报道1例原发性腹腔淋巴结新型隐球菌感染的患儿并复习相关文献,旨在加深对该病的理解,为临床医师提供借鉴。方法病例总结和文献综述。结果患儿平素健康,无免疫力缺陷。因持续发热半月余伴腹痛、咳嗽、嗜酸性粒细胞异常增高入院。影像学发现腹腔多个淋巴结肿大,采用抗生素及支持疗法,病情不能缓解,经验性给予抗真菌(氟康唑)治疗,症状好转。行腹腔镜下淋巴结活检术,病理检查证实为新型隐球菌性肉芽肿。继续抗真菌治疗,临床随访半年无复发。结论临床上出现持续发热、嗜酸性粒细胞增高、腹腔淋巴结肿大明显而中毒症状不重的患儿,在考虑可能存在恶性淋巴瘤、结核菌感染的同时,要高度警惕新型隐球菌感染的可能并行经验性抗真菌治疗,而微创手术活检或针刺取材病理学检查是明确这类疾病的可靠方法,值得在临床上推广使用。

Cryptococcal intraabdominal lymphadenitis:an unusual case report and review of the literature

Objective To report a rare case of primary cryptococcal intraabdominal lymphadenitis in a pediatric patient and review related literatures to highlight the recognition of this disease and provide clinical experience for physicians.Methods The history,clinical characteristics and outcome of the patient were summarized with literature reviews.Results The case was an immunocompetent child who presented with persistent fever accompanied by abdominal pain,cough,abnormal increase of eosinophils for more than half of a month.The imaging examination showed multiple abdominal lymphadenectasis,and antibiotics and supportive therapy were used without any improvement.Considering a possibility of fungal infections,especially cryptococcal infection,empirical antifungal treatment(Diflucan) was given.Then the fever was reduced and symptoms were improved.Subsequently,to further confirm the diagnosis and rule out potential malignant diseases,the laparoscopic surgery and lymph node biopsy were carried out showing cryptococcal granuloma.After a systemic antifungal therapy(voriconazole) the patient discharged from hospital and continued to take Diflucan orally.She is now doing well without recurrence during a clinical follow-up for six months.Conclusions The possibility of cryptococcal infection should be considered besides malignant lymphoma and tuberculosis when child has persistent fever,increased eosinophils and abdominal lymphadenectasis without severe toxic symptom.The minimal invasive surgery or fine-needle aspiration for pathological examination are the primary diagnostic methods,which are useful in clinical practice.