Micallef Clayton, Azzopardi Charles Mallia
Department of Medicine Foundation Programme, Mater Dei Hospital, Msida, Malta.
Infectious Disease Unit, Mater Dei Hospital, Msida, Malta.
BMJ Case Rep. 2014 Jun 10;2014:bcr2014204914. doi: 10.1136/bcr-2014-204914.
A 45-year-old woman, known case of seronegative arthritis and on immunosuppressive therapy, presented with a 2-week history of a macular lesion on the left calf that became papular and eventually ulcerated. The rest of the history was otherwise unremarkable and systemic examination did not reveal any abnormalities. The lesion was repeatedly biopsied but failed to reveal Leishmania donovani bodies. Concurrent Leishmania IgG was positive but IgM was negative. Leishmania IgG confirmatory testing by ELISA was negative. A biopsy from the lesion eventually tested positive for L. donovani through PCR. The patient was treated with sodium stibogluconate together with intravenous ciprofloxacin and amoxicillin to cover the secondary cutaneous bacterial infection. This led to complete resolution of the lesion.
一名45岁女性，已知患有血清阴性关节炎且正在接受免疫抑制治疗，她左小腿出现一个黄斑病变，持续2周，该病变先是变成丘疹，最终发生溃疡。其他病史无明显异常，全身检查未发现任何异常。对该病变多次进行活检，但未发现杜氏利什曼原虫体。同时检测发现利什曼原虫IgG阳性但IgM阴性。通过酶联免疫吸附测定法进行的利什曼原虫IgG确证检测为阴性。最终，病变组织活检通过聚合酶链反应检测出杜氏利什曼原虫呈阳性。该患者接受了葡萄糖酸锑钠治疗，同时静脉注射环丙沙星和阿莫西林以应对继发性皮肤细菌感染。这使得病变完全消退。
