Oren R, Schnur L F, Ben Yehuda D, Mayner V, Okon E, Rachmilewitz E A
Department of Hematology, Hadassah Hospital, Jerusalem, Israel.
J Infect Dis. 1991 Oct;164(4):746-9. doi: 10.1093/infdis/164.4.746.
In a young man who had a prolonged fever of unknown origin, hepatosplenomegaly, and progressive pancytopenia, stained smears, blood-agar cultures of bone marrow, and serologic testing for antileishmanial antibodies were negative. Biopsies from liver and bone marrow were uninformative. Visceral leishmaniasis was diagnosed only after splenectomy, when amastigotes were finally cultured from the spleen. The parasite was shown to be an unusual leishmanial parasite, possessing a mixture of intrinsic biochemical and serologic characteristics displayed independently by Leishmania tropica and Leishmania donovani sensu lato, the latter being the usual cause of visceral leishmaniasis. After splenectomy, parasites were also demonstrated in stained bone marrow aspirate smears. Recovery was uneventful after treatment with antimony for 28 days. Visceral leishmaniasis can be a cause of fever of unknown origin and should be considered in its differential diagnosis in endemic areas.
一名年轻男性长期发热，病因不明，伴有肝脾肿大和进行性全血细胞减少，染色涂片、骨髓血琼脂培养以及抗利什曼原虫抗体的血清学检测均为阴性。肝脏和骨髓活检未提供有用信息。仅在脾切除术后才诊断出内脏利什曼病，此时最终从脾脏培养出无鞭毛体。该寄生虫被证明是一种不寻常的利什曼原虫寄生虫，具有热带利什曼原虫和杜氏利什曼原虫（后者是内脏利什曼病的常见病因）各自独立表现出的内在生化和血清学特征的混合。脾切除术后，染色的骨髓穿刺涂片也显示出寄生虫。用锑治疗28天后康复顺利。内脏利什曼病可能是不明原因发热的病因，在流行地区的鉴别诊断中应予以考虑。
