每日一题_2024.01.18

A 9-year-old boy who had recently emigrated from Brazil presented to the emergency department with a 3-week history of neck swelling, fevers, and weight loss. On physical examination, there was fixed, tender lymphadenopathy in the posterior auricular, submandibular, and occipital chains. Laboratory testing was notable for peripheral eosinophilia. Tests for cryptococcus, histoplasmosis, and human immunodeficiency virus were negative. CT scan of the neck showed hyperattenuating cervical lymphadenopathy on both sides. Lymph node biopsy results are shown. What is the most likely diagnosis?

一名最近从巴西移民的9岁男童因颈部肿胀、发热和体重减轻3周到急诊科就诊。体格检查时，耳后链、下颌下链和枕骨链有固定的压痛性淋巴结肿大。值得注意的是外周嗜酸性粒细胞增多。隐球菌病、组织胞浆菌病和人类免疫缺陷病毒检测结果为阴性。颈部CT示双侧颈部淋巴结肿大。显示淋巴结活检结果。最有可能的诊断是什么?

A. Actinomycosis 放线菌病

B. Blastomycosis 芽生菌病

C. Coccidiomycosis 球孢子菌病

D. Hodgkin’s Lymphoma 霍奇金淋巴瘤

E. Paracoccidiomycosis 南美芽生菌病

答案解析：

正确答案是南美芽生菌病。淋巴结活检标本的组织病理学检查显示组织嗜酸性粒细胞增多，肉芽肿形成，以及明显的圆形结构(中间)。六胺银染色上可见成簇的酵母形态(右)。淋巴结组织聚合酶链反应检测巴西副球虫阳性。患者接受抗真菌治疗1年，症状消失。

正确答案：E