Unusual occurrence of hemophagocytic lymphohistiocytosis in HIV-positive person with visceral leishmaniasis

IF 0.3 Q4 INFECTIOUS DISEASES
I. Kooli, W. Marrakchi, A. Toumi, A. Aouam, Hammouda Baba, M. Chakroun
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Abstract

Introduction: Visceral leishmaniasis is a well-recognized opportunistic infection in people living with HIV (PLHIV). Unlike adults, in children this infection is frequently associated with hemophagocytic lymphohistiocytosis (HLH). We report a case of HLH in HIV-positive person with visceral leishmaniasis. Case description: A 25-year-old man known living with HIV since 2013 was admitted to infectious diseases department in March 2017. His clinical examination was clear. His initial viral load was 630,000 copies/mm 3 and CD4+ cells count was 12/mm 3 . No opportunistic infections were noted. The patient was started on antiretroviral therapy. During hospitalization, he developed fever, asthe-nia, rhinorrhea, and odynophagia. The diagnosis of HLH was retained because of pancytopenia, cytolysis, hyponatremia, high level of ferrinemia, and hemophagocytosis. Etiological investigations revealed positive Leishmania PCR. Also, Leishmania was detected in sternal puncture. Patient received meglumine antimoniate (glucantime) 20 mg/kg/day for 21 days with favorable outcomes. To prevent relapse, he received meglumine antimoniate 20 mg/kg/month as long as his CD4+ count was less than 100 cells/mm 3 . After 1-year follow up, no relapse was detected. Conclusions: Clinical and laboratory presentation of visceral leishmaniasis in PLHIV may differ from classic kala-azar. In our case, HLH was the reason for VL discovery.
hiv阳性内脏利什曼病患者嗜血球淋巴组织细胞增多症的罕见发生
内脏利什曼病是HIV感染者(PLHIV)中公认的机会性感染。与成人不同,在儿童中,这种感染通常与噬血细胞性淋巴组织细胞增多症(HLH)有关。我们报告一例HLH在hiv阳性的人内脏利什曼病。病例描述:一名自2013年以来已知感染艾滋病毒的25岁男子于2017年3月住进传染病科。他的临床检查很清楚。患者初始病毒载量为63万拷贝/mm 3, CD4+细胞计数为12个/mm 3。未发现机会性感染。病人开始接受抗逆转录病毒治疗。在住院期间,他出现发烧、咳嗽、流鼻水和咽痰。由于全血细胞减少、细胞溶解、低钠血症、高铁血症和噬血细胞症,HLH的诊断得以保留。病原学调查显示利什曼原虫PCR阳性。胸骨穿刺检出利什曼原虫。患者接受20 mg/kg/天的锑酸甲氨胺(葡聚糖)治疗21天,结果良好。为了防止复发,只要CD4+计数小于100个细胞/mm 3,就给予甲氨铵20 mg/kg/月。随访1年,无复发。结论:PLHIV患者内脏利什曼病的临床和实验室表现可能不同于经典黑热病。在我们的例子中,HLH是发现VL的原因。
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来源期刊
HIV & AIDS Review
HIV & AIDS Review INFECTIOUS DISEASES-
CiteScore
0.50
自引率
0.00%
发文量
30
审稿时长
12 weeks
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