Zhao Mutong, Liu Ying, Hu Zhihai, Sun Juan, Yang Zhou, Wei Li, Xu Zigang, Ma Lin
Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Department of Medical Imaging, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
J Clin Med. 2023 Feb 24;12(5):1819. doi: 10.3390/jcm12051819.
Takayasu arteritis (TA) is a rare large-vessel vasculitis that can result in significant morbidity and mortality. The coexistence of TA with leishmaniasis infection has not been reported previously. Case description: An 8-year-old girl presented with recurrent skin nodules that heal spontaneously for four years. Her skin biopsy revealed granulomatous inflammation with Leishmania amastigotes identified in the histocyte cytoplasm and the extracellular space. The diagnosis of cutaneous leishmaniasis was made and intralesional sodium antimony gluconate was started. One month later, she experienced dry coughs and fever. The CT angiography of the carotid arteries showed dilation in the right common carotid artery and thickening of artery walls with elevated acute phase reactants. The diagnosis of Takayasu arteritis (TA) was made. Reviewing her chest CT before treatment, a soft-tissue density mass was identified in the right carotid artery region, suggesting a pre-existing aneurysm. The patient was treated with surgical resection of the aneurysm with systemic corticosteroids and immunosuppressants. Her skin nodules resolved with scars after the second cycle of antimony while a new aneurysm arose due to a lack of control of TA. Conclusions: This case highlights that benign as the natural course is for cutaneous leishmaniasis, fatal comorbidities can occur as a consequence of chronic inflammation, and can be aggravated by the treatment.
高安动脉炎（TA）是一种罕见的大血管血管炎，可导致严重的发病和死亡。此前尚未报道TA与利什曼病感染并存的情况。病例描述：一名8岁女孩出现反复的皮肤结节，自行愈合四年。她的皮肤活检显示肉芽肿性炎症，在组织细胞胞质和细胞外空间中发现利什曼原虫无鞭毛体。诊断为皮肤利什曼病，并开始病灶内注射葡萄糖酸锑钠。一个月后，她出现干咳和发热。颈动脉CT血管造影显示右颈总动脉扩张，动脉壁增厚，急性期反应物升高。诊断为高安动脉炎（TA）。回顾她治疗前的胸部CT，在右颈动脉区域发现一个软组织密度肿块，提示存在先前的动脉瘤。患者接受了动脉瘤手术切除，并使用全身皮质类固醇和免疫抑制剂治疗。在第二个疗程的锑剂治疗后，她的皮肤结节留下疤痕而消退，但由于TA未得到控制，出现了一个新的动脉瘤。结论：本病例强调，尽管皮肤利什曼病的自然病程是良性的，但慢性炎症可能导致致命的合并症，并且治疗可能会使其加重。
