Durand I, Beylot-Barry M, Weill F X, Doutre M S, Beylot C
Service de Dermatologie, Hôpital du Haut-Levêque, Pessac.
Ann Dermatol Venereol. 1998 Apr;125(4):268-70.
Unlike visceral leishmaniasis, cutaneous leishmaniasis is uncommonly described in patients with human immunodeficiency virus infection. Diffuse cutaneous forms due to Leishmania infantum are always accompanied by visceral parasite infection.
We report a case of cutaneous leishmaniasis without visceral extension which was the inaugural sign of immunodeficiency virus infection. Polymerase chain reaction amplification of the genome was used to identify Leishmania infantum. Pentamidine (2 injections at the dose of 4 mg/kg, separated by one week) followed by maintenance therapy at the same dose every two weeks was given. Clinical cure was obtained after the initial injections and the intracellular parasite infestation had disappeared at the histology control.
This case was unusual in that it was the inaugural sign of HIV infection. In addition, it is the first reported case of diffuse cutaneous leishmaniasis without visceral extension of Leishmania infantum in an HIV-infected patient. As no therapeutic consensus has been established, pentamidine would appear to be interesting for this population which also requires pneumocystosis prophylaxy.
与内脏利什曼病不同，皮肤利什曼病在人类免疫缺陷病毒感染患者中较少见。婴儿利什曼原虫引起的弥漫性皮肤型总是伴有内脏寄生虫感染。
我们报告一例无内脏播散的皮肤利什曼病病例，该病例是免疫缺陷病毒感染的首发体征。采用基因组聚合酶链反应扩增来鉴定婴儿利什曼原虫。给予喷他脒（剂量为4mg/kg，分两次注射，间隔一周），随后每两周以相同剂量进行维持治疗。初次注射后获得临床治愈，组织学检查时细胞内寄生虫感染已消失。
该病例不同寻常之处在于它是HIV感染的首发体征。此外，这是首例报道的HIV感染患者中无婴儿利什曼原虫内脏播散的弥漫性皮肤利什曼病病例。由于尚未建立治疗共识，喷他脒对于该人群似乎是有意义的，该人群也需要预防肺孢子菌病。
