Williams Carla, Bass Jessica, Singh Anshika, Diemer Kelsey
Department of Internal Medicine, NCH Healthcare System, Naples, USA.
Cureus. 2022 May 29;14(5):e25442. doi: 10.7759/cureus.25442. eCollection 2022 May.
An immunocompetent 45-year-old Cuban-American man presented with worsening knee pain and swelling despite antibiotic therapy. On physical examination, the patient was ill-appearing, cachectic, with a protuberant abdomen and massive splenomegaly. In addition, he had a 10 cm area of peripheral hyperemia with central necrosis in the medial left knee that was non-tender and non-fluctuant. Initial lab work demonstrated pancytopenia, hyponatremia, hypoalbuminemia, and anemia of chronic inflammation. Peripheral smear showed microcytic, hypochromic red blood cells with mild anisopoikilocytosis. and leukopenia with slight left shift and metamyelocytes. Bone marrow biopsy demonstrated amastigotes and kinetoplasts within white blood cells and extracellular space consistent with leishmaniasis. Centers for Disease Control and Prevention (CDC) testing with PCR returned positive for . The patient received two courses of amphotericin B lipid complex (ABLC) with a 28-day course of miltefosine, which resulted in clinical improvement. This case illustrates the unique pathology that can affect immigrants and highlights the need to increase health provider awareness of foreign pathologies in areas with large migrant populations.
一名具有免疫能力的45岁古巴裔美国男子，尽管接受了抗生素治疗，但膝关节疼痛和肿胀仍不断加重。体格检查时，该患者面容不佳、消瘦，腹部突出且脾脏肿大。此外，他左膝内侧有一处10厘米大小的外周充血区域，中央坏死，无压痛且无波动感。初始实验室检查显示全血细胞减少、低钠血症、低白蛋白血症以及慢性炎症性贫血。外周血涂片显示有小细胞、低色素性红细胞，伴有轻度的红细胞大小不均和异形红细胞症，以及白细胞减少伴轻度核左移和晚幼粒细胞。骨髓活检显示白细胞内和细胞外间隙有无鞭毛体和动基体，符合利什曼病表现。疾病控制与预防中心（CDC）的PCR检测呈阳性。该患者接受了两个疗程的两性霉素B脂质复合物（ABLC）以及为期28天的米替福新治疗，病情得到临床改善。本病例说明了可能影响移民的独特病理学情况，并强调了提高医疗服务提供者对大量移民地区外来病理学认识的必要性。
