Gebel Benjamin, Rupp Jan, Kramme Evelyn
Klinik für Infektiologie und Mikrobiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck.
Dtsch Med Wochenschr. 2022 Jan;147(3):108-111. doi: 10.1055/a-1685-5173. Epub 2022 Jan 31.
The 79-year-old patient was admitted with recurring fever, weight loss, night sweat, a decrease in physical capacity and hematomas of the extremities.
The patient presented with pancytopenia, elevated CRP and impaired renal function. A splenomegaly was evident in abdominal sonography. A bone marrow aspiration was performed.
Histopathologic examination revealed a visceral Leishmaniasis. The diagnosis was confirmed by PCR from peripheral blood.
After initiation of liposomal amphotericin B haematopoiesis recovered and CRP decreased. Initially the renal function deteriorated with prolongated improvement in the course of therapy.
Pancytopenia and corresponding symptoms are suspect for visceral Leishmaniasis also in patients supposed to be immunocompetent with travel history of endemic regions.
这位79岁的患者因反复发热、体重减轻、盗汗、体能下降以及四肢出现血肿而入院。
患者出现全血细胞减少、CRP升高以及肾功能受损。腹部超声检查显示脾肿大。进行了骨髓穿刺。
组织病理学检查显示为内脏利什曼病。通过外周血PCR确诊。
开始使用脂质体两性霉素B治疗后，造血功能恢复，CRP下降。治疗过程中，肾功能最初恶化，但随后逐渐改善。
对于有流行地区旅行史的疑似免疫功能正常患者，全血细胞减少及相应症状也应怀疑为内脏利什曼病。
