疑似健康宿主马尔尼菲篮状菌感染1例并文献复习

摘要/Abstract

摘要： 患者,男,28岁,因"腹痛半个月"入院。于当地诊所抗感染治疗1周未见好转遂转入我院。体检发现双侧颌下、颏下、颈部可触及数个肿大的淋巴结,最大30 mm×30 mm,质韧,表面光滑,活动度可。无皮疹。心双肺听诊无异常。腹壁韧,中上腹压痛,无反跳痛及肌紧张,可触及包块,位于左中上腹,最大约60 mm×40 mm,不易活动。肝脾肋下未触及。肠鸣音正常,双下肢无水肿。完善淋巴结活检、下一代测序(next-generation sequencing,NGS)等相关检查,明确诊断为马尔尼菲篮状菌感染。采用两性霉素B微量泵泵入近半个月,后改用伏立康唑静脉注射半个月,出院后继续口服伏立康唑治疗2个月。患者免疫功能正常,无基础疾病,3个月后复查示:浅表淋巴结未触及肿大。腹软,全腹无压痛,无反跳痛及肌紧张,未触及腹部包块。腹部CT示:淋巴结较前减少、减小,范围较前减少。病情较前明显好转,随访中。

关键词: 马尔尼菲篮状菌, 健康宿主, 淋巴结

Abstract: A 28-year-old male patient was admitted to the hospital because of "half a month of abdominal pain". After a week of anti-infection treatment at the local clinic, he was transferred to our hospital. Physical examination revealed that several enlarged lymph nodes could be palpable bilaterally in the subjaw, subchin and neck, with a maximum of 30mm×30mm, toughness, smooth surface and good range of motion. There was no rash. Auscultation of the heart and lungs was normal. The abdominal wall was tough, the middle and upper abdomen was tender. There was no rebound pain and muscle tension, the mass could be touched, located in the left middle and upper abdomen, the maximum was about 60mm×40mm, not easy to move. The liver and spleen were not touched under the ribs. Bowel sounds were normal, and there was no edema in both lower limbs. Lymph node biopsy, next generation sequencing (NGS) and other related examinations were completed to confirm the diagnosis of Talaromyces marneffei infection. Amphotericin B was micropumped for nearly half a month, and then voriconazole was used intravenously for half a month. After discharge, oral voriconazole was continued for 2 months. The immune function of the patient was normal and there was no underlying disease. Three months later, the patient reexamined and the results showed that there was no swelling of the superficial lymph nodes. The abdomen was soft, without tenderness, rebound pain and muscle tension, and no abdominal mass was touched. Abdominal CT showed that the lymph nodes were reduced and the range was reduced. The condition improved significantly and was under follow-up.

Key words: Talaromyces marneffei, a healthy host, lymph node

中图分类号:

R 519.8

刘焕君, 郭树霞, 王艳梅, 徐小燕. 疑似健康宿主马尔尼菲篮状菌感染1例并文献复习[J]. 中国真菌学杂志, 2023, 18(3): 236-240.

LIU Huanjun, GUO Shuxia, WANG Yanmei, XU Xiaoyan. Talaromyces marneffei infection in a suspected healthy host: a case report and literature review[J]. Chinese Journal of Mycology, 2023, 18(3): 236-240.

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