Venizelos Ioannis, Tatsiou Zoi, Papathomas Thomas G, Orazi Attilio
Department of Pathology, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece.
Int J Infect Dis. 2009 Jul;13(4):e169-72. doi: 10.1016/j.ijid.2008.09.012. Epub 2008 Nov 20.
Visceral leishmaniasis (VL) is a relatively rare occurrence in rheumatoid arthritis (RA) patients treated with tumor necrosis factor-alpha (TNF-alpha) antagonists, corticosteroids and methotrexate, or methotrexate alone. A review of the literature revealed that only one case of VL in an RA patient treated with methotrexate has been previously published. We describe an additional case, that of a 65-year-old female with RA being treated with methotrexate, who presented with fever, abdominal discomfort, splenomegaly and pancytopenia. A diagnosis of VL was ultimately established, after a splenectomy was performed. Because RA is characterized by immune cell dysfunction and dysregulation, which potentially predisposes patients to infection, it is unclear whether this serious opportunistic infection can be solely attributable to the methotrexate, an immunosuppressive medication that also increases the risk of infection.
内脏利什曼病（VL）在接受肿瘤坏死因子-α（TNF-α）拮抗剂、皮质类固醇和甲氨蝶呤治疗，或仅接受甲氨蝶呤治疗的类风湿关节炎（RA）患者中相对罕见。文献回顾显示，此前仅发表过1例接受甲氨蝶呤治疗的RA患者发生VL的病例。我们描述了另外1例病例，是1名65岁接受甲氨蝶呤治疗的RA女性患者，她出现发热、腹部不适、脾肿大和全血细胞减少。在进行脾切除术后最终确诊为VL。由于RA的特征是免疫细胞功能障碍和失调，这可能使患者易发生感染，目前尚不清楚这种严重的机会性感染是否完全归因于甲氨蝶呤，这种免疫抑制药物也会增加感染风险。
