N Gestels, E Bottieau, A De Vooght, S van Ierssel, S Libbrecht, A Driessen, S Francque, T Vanwolleghem, W J Kwanten
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引用次数: 0
摘要
内脏利什曼病（VL）是一种严重的病媒寄生虫病，在多个热带国家和地中海盆地流行。我们报告了一例 64 岁免疫功能正常的男性病例，他最近去葡萄牙旅行后出现黄疸、发热、脾肿大、高铁蛋白血症和细胞减少症。临床和生化检查结果与急性胆汁淤积性肝炎和嗜血细胞淋巴组织细胞增多症（HLH）的诊断一致，继发于婴儿内脏利什曼病，后经骨髓检查确诊。尽管使用脂质体两性霉素 B 进行了充分治疗，但疾病和 HLH 还是复发了。使用更大剂量的再治疗最终获得成功。该病例凸显了在南欧感染 VL 的风险及其可能出现的异常表现，从而导致诊断延误，以及需要进行适当的多学科沟通的复杂治疗。
An unusual case of acute cholestatic hepatitis: visceral leishmaniasis with secondary haemophagocytic lymphohistiocytosis.
Visceral leishmaniasis (VL) is a severe vector-borne parasiti disease, endemic in various tropical countries but also in the Mediterranean Basin. We report the case of a 64-year-old immunocompetent male, who presented with jaundice, fever, splenomegaly, hyperferritinaemia and cytopenias after a recent trip to Portugal. Clinical and biochemical findings were consistent with the diagnosis of an acute cholestatic hepatitis and haemophagocytic lymphohistiocytosis (HLH), secondary to visceral Leishmania infantum which was later confirmed by bone marrow examination. Despite adequate therapy with liposomal amphotericin B, the disease and HLH relapsed. Retreatment with higher dosing was eventually successful. This case highlights the risk of acquiring VL in southern Europe and its possible unusual presentations, causing diagnostic delay, as well as its complex management that requires appropriate multidisciplinary communication.
期刊介绍：
The Journal Acta Gastro-Enterologica Belgica principally publishes peer-reviewed original manuscripts, reviews, letters to editors, book reviews and guidelines in the field of clinical Gastroenterology and Hepatology, including digestive oncology, digestive pathology, as well as nutrition. Pure animal or in vitro work will not be considered for publication in the Journal. Translational research papers (including sections of animal or in vitro work) are considered by the Journal if they have a clear relationship to or relevance for clinical hepato-gastroenterology (screening, disease mechanisms and/or new therapies). Case reports and clinical images will be accepted if they represent an important contribution to the description, the pathogenesis or the treatment of a specific gastroenterology or liver problem. The language of the Journal is English. Papers from any country will be considered for publication. Manuscripts submitted to the Journal should not have been published previously (in English or any other language), nor should they be under consideration for publication elsewhere. Unsolicited papers are peer-reviewed before it is decided whether they should be accepted, rejected, or returned for revision. Manuscripts that do not meet the presentation criteria (as indicated below) will be returned to the authors. Papers that go too far beyond the scope of the journal will be also returned to the authors by the editorial board generally within 2 weeks. The Journal reserves the right to edit the language of papers accepted for publication for clarity and correctness, and to make formal changes to ensure compliance with AGEB’s style. Authors have the opportunity to review such changes in the proofs.
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