播散性隐球菌病伴嗜酸性粒细胞增高一例

Disseminated Cryptococcosis with Eosinophilia: A Case Report

摘要: 目的：探讨隐球病临床表现、诊断和治疗。方法：对我科诊断播散性隐球菌病患者的临床材料进行回顾性分析。结果：患者因发热半月余住院，血培养、骨髓培养均培养出新型隐球菌。予两性霉素B及氟胞嘧啶规律治疗4周后患儿体温恢复正常，复查血常规示白细胞、嗜酸性粒细胞计数及比例较前显著下降,肺部影像好转。序贯口服伏立康唑(氟康唑不敏感)治疗6月，患儿病情稳定，未再发热，嗜酸性粒细胞计数、肺部影像恢复正常。结论：在临床工作中，无基础疾病患儿有反复发热、伴嗜酸性粒细胞增高的临床表现,且使用足量、足疗程抗生素抗感染治疗仍无效时，需警惕真菌感染。

Abstract: Objective: To investigate the clinical manifestations, diagnosis and treatment of disseminated cryptococcosis. Methods: The clinical data of one child with disseminated cryptococcosis diagnosed by our department were analyzed retrospectively. Results: The child was advised to be hospitalized because of frequently fever. Blood culture and bone marrow culture were performed to produce Cryptococcus neoformans. After treatment with amphotericin B and cytosine for 4 weeks, the child’s body temperature returned to normal. The blood routine examination showed that the WBC count, eosinophil count and proportion decreased significantly, and the pulmonary image recovery. After discharge of sequential oral voriconazole (fluconazole sensitive) treatment for six months, children had stable condition, no fever, eosinophil count and lung image returned to normal. Conclusion: In clinical practice, patients with no underlying diseases have the clinical manifestations of recurrent fever and eosinophilia frequently and antibiotic with adequate dosage and duration treatment is invalid, we should consider fungal infection.