McQuarrie Shauna, Kasper Ken, Moffatt Dana C, Marko Daniel, Keynan Yoav
Manitoba HIV Program;
Manitoba HIV Program;; Department of Internal Medicine, University of Manitoba;
Can J Infect Dis Med Microbiol. 2015 Nov-Dec;26(6):325-9. doi: 10.1155/2015/176545.
The present report documents a 49-year-old HIV-infected man receiving antiretroviral therapy with a suboptimal immune response and a CD4 count of 95 cells/mm(3), despite virological suppression. Investigation of bone marrow was conducted and yielded a diagnosis of visceral leishmaniasis. The clinical course was complicated by gastrointestinal involvment and relapse occurred after amphotericin B therapy. With the addition of miltefosine, the patient no longer presented with bone marrow amastigotes, and displayed an increased CD4 count and negative Leishmania polymerase chain reaction results. The present case highlights atypical presentation of visceral leishmaniasis, including poor immune reconstitution and gastrointestinal involvement. The high likelihood of relapse and response to combination therapy are illustrated.
本报告记录了一名49岁的HIV感染男性，尽管病毒学得到抑制，但接受抗逆转录病毒治疗时免疫反应欠佳，CD4细胞计数为95个/立方毫米。对其进行了骨髓检查，诊断为内脏利什曼病。临床病程因胃肠道受累而复杂化，两性霉素B治疗后出现复发。加用米替福新后，患者骨髓中不再有无鞭毛体，CD4细胞计数增加，利什曼原虫聚合酶链反应结果为阴性。本病例突出了内脏利什曼病的非典型表现，包括免疫重建不良和胃肠道受累。说明了复发的高可能性以及联合治疗的反应。
