Kotsifas Konstantinos, Metaxas Eugenios, Koutsouvelis Ioannis, Skoutelis Athanassios, Kara Panayiota, Tatsis George
Pulmonary Medicine Department, Evaggelismos General Hospital, 45-47 Ypsilantou Street, 10676 Athens, Greece.
Case Rep Med. 2011;2011:561985. doi: 10.1155/2011/561985. Epub 2011 Mar 10.
Visceral leishmaniasis is characterized by fever, cachexia, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Cough may be a presenting symptom as well. However, pulmonary involvement is considered rare and mainly described in immunocompromised patients. We describe a case of an immunocompetent adult whose clinical presentation was dominated by cough and hemoptysis. Bronchoscopy revealed a discreet polypoid mucosal endobronchial lesion whose biopsy yielded Leishmania amastigotes within histiocytes. Transbronchial needle biopsy of a right paratracheal lymph node was also positive. Leishmania amastigotes were also found on bone marrow and liver biopsies. Treatment with IV Amphotericin B was successful. In conclusion, cough should not be overlooked as a presenting symptom of visceral leishmaniasis and may be a sign of pulmonary involvement.
内脏利什曼病的特征为发热、恶病质、肝脾肿大、全血细胞减少和高球蛋白血症。咳嗽也可能是首发症状。然而，肺部受累被认为较为罕见，主要见于免疫功能低下的患者。我们报告一例免疫功能正常的成年人，其临床表现以咳嗽和咯血为主。支气管镜检查发现一个边界清晰的息肉样支气管内黏膜病变，活检在组织细胞内发现利什曼原虫无鞭毛体。经支气管针吸活检右侧气管旁淋巴结也呈阳性。骨髓和肝脏活检也发现了利什曼原虫无鞭毛体。静脉注射两性霉素B治疗成功。总之，咳嗽作为内脏利什曼病的首发症状不应被忽视，可能是肺部受累的迹象。
