肝移植术后髋关节新型隐球菌感染1例并文献复习

目的报道1例肝移植术后髋关节新型隐球菌感染病例及相关文献复习,关注此病的发生及诊治。方法回顾性分析1例肝移植术后髋关节新型隐球菌感染病例,并以英文关键词“Cryptococcus”和“joint”或“arthritis”、中文关键词“隐球菌感染”和“关节”为检索词,检索PubMed数据库、中国知网数据库(CNKI)、万方数据库和维普数据库等国内外报道的病例,结合文献复习综合分析关节隐球菌感染的临床特点及诊疗方法。结果患者男性,39岁,因“左侧髋部肿痛2个月”入院,既往因肝硬化在外院行同种异体原位肝移植术,术后长期口服抗免疫排斥药物及激素治疗。髋关节经穿刺引流液培养确诊为新型隐球菌感染,严格抗真菌治疗后好转。文献共检索到9例关节隐球菌感染患者,其中男性5例,女性4例,年龄4~92岁;主要受累部位是膝关节4例,其次是髋关节3例。8例的临床症状仅表现为局部肿痛,1例合并发热;影像学多表现为关节周围溶骨性病变5例,其中2例合并局部软组织肿物形成。经及时手术干预和(或)抗真菌治疗后,7例患者治愈且随访未见复发,1例于出院3个月后不明原因死亡,1例确诊后要求转院失访。结论关节隐球菌感染的临床及影像学表现均缺乏特异性,极易与肿瘤、结核等疾病相混淆,当临床上怀疑本病时,应尽早行穿刺液或组织病原学检测,以免误诊和延误治疗造成严重后果。

Cryptococcus neoformans infection in hip joint after liver transplantation:one case report and literature review

Objective To report a case of Cryptococcus neoformans infection in hip joint after liver transplantation and review the related literature.Methods One case of C.neoformans infection in hip joint after liver transplantation was reviewed.Similar cases were retrieved from PubMed database,CNKI,Wanfang,and VIP databases.The clinical characteristics,diagnosis,and treatment of joint infection due to C.neoformans were comprehensively analyzed.Results A 39-year-old male was admitted to the hospital because of"swelling and pain in the left hip for 2 months".He underwent orthotopic liver transplantation due to liver cirrhosis,and treated with oral anti-rejection drugs and corticosteroids for a long time.C.neoformans infection of the hip joint was diagnosed by culture of the drainage.The infection improved after antifungal treatment.A total of 9 patients with C.neoformans-related joint infection were retrieved,including 5 males and 4 females(4 to 92 years of age).The most common site of infection was knee joint(4/9),followed by hip joint(3/9).Majority of patients(8/9)only had clinical symptoms of local swelling and pain.One patient was complicated with fever.Osteolytic lesions around the joint(5/9)were the most common findings on imaging study.Two patients were complicated with local soft tissue mass formation.After timely surgical intervention and/or antifungal therapy,majority(7/9)of the patients were cured.No recurrence was found during follow-up.One patient died of unknown cause 3 months after discharge.Another patient lost to follow-up after diagnosis due to transfer to another hospital.Conclusions Both the clinical and imaging manifestations of C.neoformans-related joint infection are not specific,which is readily confused with tumors or tuberculosis.When this disease is suspected clinically,joint puncture or biopsy should be performed to obtain specimens for etiological diagnosis as soon as possible to avoid serious consequences caused by misdiagnosis and delayed treatment.