RESUMO
Leishmaniasis is a parasitic disease caused by the protozoa of the genus Leishmania transmitted by sandfly bites. It causes subclinical infection and diverse clinical manifestations with cutaneous, mucosal or visceral involvement. The last one, called visceral leishmaniasis, is usually fatal without treatment and in VIH patients with deep immunosuppression, has been recognized as an opportunistic infection with a high degree of difficulty in diagnosis and treatment. We present the case of a patient with HIV infection and visceral leishmaniasis. The clinical presentation was a prolonged febril syndrome with hepatosplenomegaly, lymphadenopathy and pancytopenia. The differential diagnosis was made with lymphoma and other opportunistic infections, as mycobacteriosis. The bone marrow aspirate reveled parasite amastigotes. The patient received treatment with amphotericin B deoxycholate for 14 days and 2 months after he relapsed. Then he was treated with the same drug for 21 days and after that he has been in prophylaxis for 29 months with good outcome, without any other relapse.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Leishmaniose Visceral/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Humanos , Leishmaniose Visceral/tratamento farmacológico , Masculino , Pessoa de Meia-IdadeRESUMO
Leishmaniasis is a parasitic disease caused by the protozoa of the genus Leishmania transmitted by sandfly bites. It causes subclinical infection and diverse clinical manifestations with cutaneous, mucosal or visceral involvement. The last one, called visceral leishmaniasis, is usually fatal without treatment and in VIH patients with deep immunosuppression, has been recognized as an opportunistic infection with a high degree of difficulty in diagnosis and treatment. We present the case of a patient with HIV infection and visceral leishmaniasis. The clinical presentation was a prolonged febril syndrome with hepatosplenomegaly, lymphadenopathy and pancytopenia. The diferential diagnosis was made with lymphoma and other opportunistic infections, as mycobacteriosis. The bone marrow aspirate reveled parasite amastigotes. The patient received treatment with amphotericin B deoxycholate for 14 days and 2 months after he relapsed. Then he was treated with the same drug for 21 days and after that he has been in prophylaxis for 29 months with good outcome, without any other relapse.
La leishmaniosis es una infección producida por parásitos del género Leishmania, transmitida por mosquitos hematófagos. Puede ocasionar infecciones subclínicas o manifestarse con compromiso cutáneo, mucoso o visceral. Esta última forma de presentación, que constituye la leishmaniosis visceral, es la más grave pudiendo llegar a ser fatal y en los pacientes con infección por VIH se presenta como una infección oportunista de difícil diagnóstico y tratamiento. Se reporta el caso de un paciente con infección por VIH con leishmaniosis visceral cuyo cuadro clínico se presentó como un síndrome febril prolongado con hepato-esplenomegalia, linfadenopatías y pancitopenia. Se plantearon los diagnósticos diferenciales de linfoma y otras infecciones oportunistas, como mico-bacteriosis. La demostración de amastigotes del parásito en el aspirado de médula ósea confirmó el diagnóstico. El paciente se trató con anfotericina B deoxicolato por 14 días y a los 2 meses presentó una recaída por lo cual recibió un segundo curso con el mismo medicamento por 21 días y se mantuvo posteriormente con profilaxis secundaria. Además se realizó cambio de la TAlRV por fracaso virológico e inmunológico. Ha continuado controlándose en forma ambulatoria por 29 meses presentando evolución satisfactoria, sin nuevas recaídas.