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目的报告一例播散性隐球菌病的临床、实验研究和治疗结果。方法和结果患者女,33岁。1年前上臂、肩、臀及大腿长结节,此间怀孕并早产。产后半个月新发结节泛发全身。3个月前诊断为“血源播散性肺结核”,但抗结核治疗无效。体检发现面部、牙龈、躯干、臀部及四肢共39个结节和溃疡,左胫、腓骨骨质破坏及窦道。脓涂片及病理活检见脓液和坏死组织内有大量真菌孢子,培养酵母样菌落生长,尿素酶及咖啡酸试验阳性。经API酵母菌反应条和血清学鉴定为新生隐球菌血清型A。将菌种接种于大小鼠后发现脑、肺、肝等易受累。临床分离株核糖体内转录间隔2区序列分析法鉴定为新生隐球菌新生变种。停抗结核药,用抗真菌药治疗。强化段用两性霉素B和氟康唑,维持段口服伊曲康唑。局部用两性霉素B。30d后结节消失,200d后溃疡和窦道全部愈合,277d时停抗真菌药,患者痊愈。
Objective To report a case of disseminated cryptococcosis clinical, experimental research and treatment results. Methods and Results Patients Female, 33 years old. A year ago, the upper arm, shoulder, buttocks and thigh long nodules, during pregnancy and premature birth. New hair nodules half a month after the generalized body. 3 months ago diagnosed as “blood-borne tuberculosis,” but anti-TB treatment ineffective. A total of 39 nodules and ulcers of the face, gums, trunk, buttocks and extremities were found on the physical examination, and the destruction of the left tibia and fibula and the sinuses. Pus smear and pathological biopsy see pus and necrotic tissue with a large number of fungal spores, yeast culture-like colonies growth, urease and caffeic acid test was positive. Cryptococcus neoformans serotype A was identified by API yeast reaction strip and serology. The bacteria inoculated in rats and mice found that brain, lung, liver and other vulnerable to involvement. Clinical isolates were identified as Cryptococcus neoformans by ribosomal transcribed spacer region 2 sequence analysis. Stop anti-tuberculosis drugs, anti-fungal drug treatment. Fortified with amphotericin B and fluconazole, to maintain the segment oral itraconazole. Topical amphotericin B After 30d nodules disappeared, 200d after ulcers and sinus all healed, 277d stop antifungal drug, the patient recovered.