Abstract
History: patient, female, 24 years old, studied in San Francisco for half a year, four months ago appear low grade fever, cough, improvedwith antibiotics and cough medicine after 1 week. Three months ago, she found some lumps in both side of the neck neoplasm, progressive increase, swelling, surface burst festering. Also found the back of hand wrist swelling. Since the onset, she has lost the weight and appetite.
Physical examination: Multiple lesions were found in bilateral neck and the right hand wrist (see photo), cardiopulmonary abdominal negative.
Auxiliary examination
Routine blood WBC 9.89×10^9,L 26.64%，N 58.84%，M 10.04%，E % 4.44%，RBC 4.57 ×10^12, Hb 105g/L，HCT 0.316L，PLT 319 ×10^9，CRP 10.52(0-3) mg/L; ESR 45mm/h，A recent review 42 mm/h;Immune function IgG 26(7-16)IU/L，IgE IgE2690 (0-358) IU/L ,others normal, HIVnegative; Parasites: lung trematode, toxoplasmaantibody negative. All TB test negative.
One month ago , the biopsy proved to becoccidioidomycosis by a Japan pathologist. and the fungal culture also support this diagnosis.
Imaging examination: chest X - ray did not see lung nodule, cranial MRI did not see intracranial lesions. Ultrasound: bilateral neck, armpits, multiple enlarged lymph nodes, the neck, right wrist multiple abscess formation.
Treatment Early anti-tuberculosis treatment for 10 days, invalid, After diagnose clearly, Ambsome( amphotericin B liposome, buy from HK) was given injection with 100 mg for 7 days, 150 mg for 8 days.At the same time combined itraconazole oral liquid (Spain) 400 mg per day. After the treatment, the neck abscess became smaller, but the wound does not heal, the abscess on the back of the handremained red.
Problem: The treatment for more than a month, the effect is not ideal, recently have low fever, ESR still fast. Are there any American doctors who have the experience to treat this disease can give us some help? Whether to maintain the original treatment? Increase the dose? Period of treatment is not enough? Recommend other treatments? Thank you very much.
History: patient, female, 24 years old, studied in San Francisco for half a year, four months ago appear low grade fever, cough, improvedwith antibiotics and cough medicine after 1 week. Three months ago, she found some lumps in both side of the neck neoplasm, progressive increase, swelling, surface burst festering. Also found the back of hand wrist swelling. Since the onset, she has lost the weight and appetite.
Physical examination: Multiple lesions were found in bilateral neck and the right hand wrist (see photo), cardiopulmonary abdominal negative.
Auxiliary examination
Routine blood WBC 9.89×10^9,L 26.64%，N 58.84%，M 10.04%，E % 4.44%，RBC 4.57 ×10^12, Hb 105g/L，HCT 0.316L，PLT 319 ×10^9，CRP 10.52(0-3) mg/L; ESR 45mm/h，A recent review 42 mm/h;Immune function IgG 26(7-16)IU/L，IgE IgE2690 (0-358) IU/L ,others normal, HIVnegative; Parasites: lung trematode, toxoplasmaantibody negative. All TB test negative.
One month ago , the biopsy proved to becoccidioidomycosis by a Japan pathologist. and the fungal culture also support this diagnosis.
Imaging examination: chest X - ray did not see lung nodule, cranial MRI did not see intracranial lesions. Ultrasound: bilateral neck, armpits, multiple enlarged lymph nodes, the neck, right wrist multiple abscess formation.
Treatment Early anti-tuberculosis treatment for 10 days, invalid, After diagnose clearly, Ambsome( amphotericin B liposome, buy from HK) was given injection with 100 mg for 7 days, 150 mg for 8 days.At the same time combined itraconazole oral liquid (Spain) 400 mg per day. After the treatment, the neck abscess became smaller, but the wound does not heal, the abscess on the back of the handremained red.
Problem: The treatment for more than a month, the effect is not ideal, recently have low fever, ESR still fast. Are there any American doctors who have the experience to treat this disease can give us some help? Whether to maintain the original treatment? Increase the dose? Period of treatment is not enough? Recommend other treatments? Thank you very much.
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