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以纵隔淋巴结肿大为突出表现的儿童肺隐球菌病3例报告

张晓艳 赵顺英 周春菊

张晓艳, 赵顺英, 周春菊. 以纵隔淋巴结肿大为突出表现的儿童肺隐球菌病3例报告[J]. 四川大学学报(医学版), 2021, 52(5): 859-861. doi: 10.12182/20210960204
引用本文: 张晓艳, 赵顺英, 周春菊. 以纵隔淋巴结肿大为突出表现的儿童肺隐球菌病3例报告[J]. 四川大学学报(医学版), 2021, 52(5): 859-861. doi: 10.12182/20210960204
ZHANG Xiao-yan, ZHAO Shun-ying, ZHOU Chun-ju. Case Report: Three Pediatric Pulmonary Cryptococcosis Patients with Prominent Manifestation of Mediastinal Lymphadenopathy[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2021, 52(5): 859-861. doi: 10.12182/20210960204
Citation: ZHANG Xiao-yan, ZHAO Shun-ying, ZHOU Chun-ju. Case Report: Three Pediatric Pulmonary Cryptococcosis Patients with Prominent Manifestation of Mediastinal Lymphadenopathy[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2021, 52(5): 859-861. doi: 10.12182/20210960204

以纵隔淋巴结肿大为突出表现的儿童肺隐球菌病3例报告

doi: 10.12182/20210960204
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Case Report: Three Pediatric Pulmonary Cryptococcosis Patients with Prominent Manifestation of Mediastinal Lymphadenopathy

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  • 摘要: 本文报道3例以纵隔淋巴结肿大为突出表现的儿童肺隐球菌病。3例患儿既往均体健;2例有鸽子和家禽接触史。3例均表现为长期发热,伴轻咳;肺部无明显阳性体征,1例颈部淋巴结肿大;3例外周血白细胞、中性粒细胞及血清C-反应蛋白(CRP)均升高;2例血隐球菌荚膜多糖抗原阳性;3例体液免疫(IgA,IgM,IgG,IgE)及淋巴细胞亚群均正常,人类免疫缺陷病毒(HIV)抗体均阴性;3例患儿胸片及肺CT均示明显的纵隔淋巴结肿大,1例伴肺内结节。2例纵隔淋巴结活检示肉芽肿性炎,找到大量隐球菌孢子;此3例诊断肺隐球菌病,其中2例为确诊,1例为临床诊断。2例单独使用氟康唑治疗,合并脾播散的1例初始1个月联合两性霉素B治疗,继予氟康唑维持;总疗程5~9个月,均治愈。因此,免疫功能正常儿童肺隐球菌病可以纵隔淋巴结肿大为突出/孤立表现,在鉴别诊断中需考虑此点;氟康唑单用或者必要时加用两性霉素B治疗效果良好。
  • 图  1  肺部影像表现

    Figure  1.  Pulmonaryimaging findings

    A: Markedly enlarged mediastinal lymph nodes; B: Multiple enlarged mediastinal lymph nodes with slight ring enhancement; C: Scattered nodules in parenchyma.

    图  2  纵隔淋巴结病理。 ×40

    Figure  2.  Mediastinal lympha node biopsy. ×40

    Abundant fungal yeasts with capsules were seen in PAS staining (A) and GMS staining (B) of mediastinal lymph node biopsy.

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出版历程
  • 收稿日期:  2021-06-04
  • 修回日期:  2021-08-12
  • 网络出版日期:  2021-12-06
  • 刊出日期:  2021-09-20

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