Mouri Oussama, Benhamou Mathilde, Leroux Gaëlle, Chartrel Nathalie, Devidas Alain, Thellier Marc, Amoura Zahir, Costedoat-Chalumeau Nathalie, Buffet Pierre
AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie, F-75013, Paris, France.
AP-HP, Hôpital Cochin, Service de Rééducation et Réadaptation, F-75014, Paris, France.
BMC Infect Dis. 2015 Oct 23;15:445. doi: 10.1186/s12879-015-1191-6.
Visceral leishmaniasis (VL), i.e., infection with Leishmania sp. associated with high fever, weight loss, massive splenomegaly and markedly altered laboratory parameters, is generally fatal if untreated. The possibility of transient spontaneous remission of fully symptomatic visceral leishmaniasis (VL) has been mentioned but, to our knowledge) has never been documented.
We report the first documented history of a patient with overt, confirmed VL experiencing a complete remission in the absence of any anti-leishmanial therapy. The diagnosis of VL at the time of the self-resolving episode was strongly suspected based on clinical presentation and presence of antileishmanial antibody, then unequivocally confirmed years later by the presence of an amastigote on a stored smear and the positive quantitative PCR with Leishmania-specific primers from the material scraped from this same slide
This report demonstrates that complete spontaneous remission may occur in patients with overt, fully symptomatic VL. VL should therefore be considered in cases of self-resolving or relapsing episodes of fever of unknown origin. Confirmation should be based on both serological tests and specific PCR on a blood sample.
内脏利什曼病（VL），即感染利什曼原虫，伴有高热、体重减轻、脾脏肿大及实验室参数显著改变，若不治疗通常会致命。完全有症状的内脏利什曼病（VL）可能出现短暂自发缓解的情况虽有提及，但据我们所知，从未有过记录。
我们报告了首例有记录的明显确诊内脏利什曼病患者在未接受任何抗利什曼治疗的情况下完全缓解的病史。在自行缓解期时，根据临床表现和抗利什曼抗体的存在强烈怀疑为内脏利什曼病诊断，数年后通过储存涂片上存在无鞭毛体以及从同一张玻片刮取的材料进行利什曼原虫特异性引物的定量PCR阳性明确确诊。
本报告表明，明显的、完全有症状的内脏利什曼病患者可能会出现完全自发缓解。因此，对于不明原因发热自行缓解或复发的病例应考虑内脏利什曼病。确诊应基于血清学检测和血样的特异性PCR。
