Alejandro De La Hoz, Nirupa Gadi, Christina G Lopez, Alejandro Barrera-Godinez, Nancy S Miller, Daniel L Bourque, Candice Brem, Ekin Ozluk, Geetika Seth, Sarah Kimball, Jessica L Taylor
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引用次数: 0
摘要
迁徙路线决定了接触地方性传染病的机会。我们报告了一例复杂皮肤利什曼病病例,患者是一名艾滋病毒感染者,从利什曼病不常见的海地移居美国,途经南美洲和中美洲时感染了利什曼病。他的症状包括四肢、胸部、背部、面部、手掌和脚底出现色素沉着、非溃疡性斑块和结节,最初没有粘膜病变。聚合酶链反应证实他感染了帕纳曼利什曼病。医生给他开了比特格韦/替诺福韦-阿拉非那胺/恩曲他滨治疗弥漫性皮肤利什曼病,可快速抑制艾滋病毒,并使用两性霉素 B 脂质体治疗,但最初的反应有限。随后,他在免疫重建的情况下出现了粘膜病变,并再次接受了针对粘膜病的两性霉素治疗。详尽的迁徙史对诊断至关重要。本病例强调了利什曼病在艾滋病病毒感染者中的不同表现形式以及治疗失败的高风险。
Immune Reconstitution Inflammatory Syndrome in a Patient With Cutaneous Leishmaniasis and HIV: A Diagnostic Challenge for Clinicians Caring for a Migrant Population in the United States.
Migration routes determine exposure to endemic infections. We present a case of complex cutaneous leishmaniasis in a man with HIV infection who migrated to the United States from Haiti, where Leishmania is uncommon, acquiring leishmaniasis while on his journey via South America and Central America. His presentation included hyperpigmented, nonulcerated plaques and nodules on his extremities, chest, back, face, palms, and soles; initially he had no mucosal lesions. Infection with Leishmania panamensis was confirmed via polymerase chain reaction. He was prescribed bictegravir/tenofovir alafenamide/emtricitabine with rapid suppression of HIV and liposomal amphotericin B for diffuse cutaneous leishmaniasis with a limited initial response. He subsequently developed mucosal lesions in the setting of immune reconstitution and was retreated with amphotericin dosed for mucocutaneous disease. A thorough migration history was critical to diagnosis. This case highlights the different presentations of leishmaniasis in people with HIV and the elevated risk for treatment failure.
期刊介绍:
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.