Infectious Diseases Department, Caen University Hospital, Caen, France.
Virology Department, Normandie Univ, UNICAEN, Normandie University Hospital, Caen, France.
Front Immunol. 2021 Apr 21;12:669723. doi: 10.3389/fimmu.2021.669723. eCollection 2021.
We report a case of a severe visceral leishmaniasis revealing an HIV-1 infection presenting as an acute primary infection. A young French man living in Paris with history of unprotected sex with a recent male partner and recent travel in Greece was admitted in our Infectious Diseases Department, presenting with acute febrile psychotic disorder, and positive HIV-1 serology with high viral load, very low CD4 T-cells count and a western blot pattern suggesting an acute infection. The psychotic disorder was finally related to hemophagocytic lymphohistiocytosis diagnosed on bone marrow aspiration, supposedly secondary to HIV acute primary infection. The progressive worsening of pancytopenia despite antiretroviral treatment and the persistence of fever, chills and sweat led to the diagnosis of visceral leishmaniasis through bone marrow biopsy and leishmanial serology. He was treated with intravenous liposomal amphotericin B with quick improvement. We discuss the way HIV infection and visceral leishmaniasis may have interact to lead to the clinical presentation of our patient.
我们报告了一例严重内脏利什曼病，该疾病表现为急性原发性感染，同时揭示了 HIV-1 感染。一位居住在巴黎的年轻法国男性，有与近期男性伴侣发生无保护性行为的病史，以及近期在希腊旅行的经历，因急性发热性精神病而被收入我们的传染病科，同时 HIV-1 血清学呈阳性，病毒载量很高，CD4 T 细胞计数非常低，且 Western blot 模式表明为急性感染。该精神病最终与骨髓抽吸诊断为噬血细胞性淋巴组织细胞增生症相关，推测为 HIV 急性原发性感染的继发症。尽管进行了抗逆转录病毒治疗，但全血细胞减少症仍在不断恶化，且持续发热、寒战和出汗，导致通过骨髓活检和利什曼血清学诊断为内脏利什曼病。他接受了静脉注射两性霉素 B 脂质体治疗，病情迅速改善。我们讨论了 HIV 感染和内脏利什曼病如何相互作用，导致了我们患者的临床表现。
