Laboratorio de Referencia Nacional de Leishmaniasis, Instituto Nacional de Salud, Lima, Perú.
Instituto Nacional de Salud del Niño, Lima, Perú.
Rev Peru Med Exp Salud Publica. 2023 Jan-Mar;40(1):94-98. doi: 10.17843/rpmesp.2023.401.11481. Epub 2023 Jun 23.
We present a case of disseminated cutaneous leishmaniasis with extensive manifestation in a pediatric patient with Down syndrome. The case was confirmed by parasitological and immunological tests. The species was identified as Leishmania (Viannia) braziliensis by polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP). The immune deficit that occurs as part of Down syndrome may have been the reason for the aggressive and prolonged clinical manifestations as well as the poor response to stibogluconate and deoxycholate amphotericin. The patient was treated with liposomal amphotericin B and at the end of therapy, showed clinical improvement of the lesions. This report highlights the challenges of the diagnosis and treatment of cutaneous leishmaniasis in immunosuppressed pediatric patients, especially under difficult social, economic and geographic conditions. Leishmaniasis should be considered as a differential diagnosis when treating atypical chronic dermatologic ulcers; the use of liposomal amphotericin in immunocompromised patients should also be considered in these cases.
我们报告了一例儿童唐氏综合征患者广泛表现的播散性皮肤利什曼病。该病例通过寄生虫学和免疫学检查得到证实。通过聚合酶链反应-限制性片段长度多态性（PCR-RFLP）鉴定该物种为利什曼原虫（Viannia）巴西利什曼原虫。唐氏综合征所导致的免疫缺陷可能是导致该病例临床表现侵袭性和长期性以及对葡聚糖硫酸酯和去氧胆酸盐两性霉素 B 反应不佳的原因。该患者接受了脂质体两性霉素 B 治疗，在治疗结束时，病变的临床症状得到了改善。本报告强调了在免疫抑制的儿科患者中诊断和治疗皮肤利什曼病的挑战，特别是在社会、经济和地理条件困难的情况下。在治疗非典型慢性皮肤病性溃疡时，应将利什曼病作为鉴别诊断；在这些情况下，也应考虑在免疫功能低下的患者中使用脂质体两性霉素。
