每日一题_2026.02.12

A 23-year-old man presented to the emergency department with a 2-month history of unintentional weight loss and worsening abdominal pain and distension. The patient had recently moved to Arizona from a remote Pacific Island. Physical examination was notable for a firm abdomen with diffuse tenderness to palpation. A diagnostic laparoscopy revealed peritoneal nodules and inflammatory adhesions. A peritoneal biopsy and computed tomography of the chest, abdomen, and pelvis are shown. Which of the following is the most likely etiology of the peritoneal nodules?

一名23岁男性因“无意识体重减轻2个月，伴腹部疼痛和腹胀逐渐加重”到急诊科就诊。患者最近从偏远的太平洋岛屿搬到亚利桑那州。体格检查发现腹部触之质硬，并有弥漫性压痛。诊断性腹腔镜检查显示腹膜有结节和炎性粘连。腹膜活检及胸、腹、盆腔CT结果如图所示。以下哪项最可能是这些腹膜结节的病因？

A. Carcinomatosis from intraabdominal malignancy来自腹腔恶性肿瘤的癌转移

B. Coccidioidomycosis球孢子菌病

C. Mesothelioma间皮瘤

D. Sarcoidosis结节病

E. Tuberculosis结核病

答案解析：

腹膜活检的组织病理学分析显示：坏死性肉芽肿，伴大型厚壁球形体（spherules）；腹膜组织的真菌培养生长出球孢子菌（Coccidioides）。最终诊断为腹膜球孢子菌病。给予长期氟康唑治疗。出院后1个月随访，患者症状已缓解。

正确答案：B