Lupus Nefriti ile Karışan Visseral Leishmaniasis Olgusu

Öz

Leismania enfekte kum sinekleri ile memelilere aktarılan hücre içi bir parazittir. Kutanöz, visseral ve mukokutanöz leishmaniasis olmak üzere üç klinik formu bulunmaktadır. Tanısal beş temel özelliği ateş, kilo kaybı, hepatosplenomegali, pansitopeni ve hipergammaglobulinemidir. Bu bulgularla otoimmun veya hematolojik hastalıklar ile karışabilmektedir. Burada endemik olmayan bir bölgede tanı konulan lupus nefriti ile karışan bir visseral leishmaniasis (VL) olgusu sunulmuştur. Kırkdokuz yaşında erkek hasta ateş, kilo kaybı, hepatosplenomegali, pansitopeni nedeniyle bölge hastanesinde bir süre takip edilmiştir. Daha sonra hematolojik malignite ve vaskülit öntanıları ile hastanemize sevk edilmiştir. Hastada malignite bulgusu saptanmamıştır. Akut böbrek yetmezliği gelişen hastada sistemik lupus eritematozis böbrek ve hematolojik tutulumu düşünülmüştür. Böbrek histopatolojisi fokal proliferatif nekrotizan glomerülonefrit olarak sonuçlanmıştır. Leishmania spp. PCR ve Lesihmania spp IgG pozitif saptanmıştır. Visseral leishmaniasis tanısı ile yedi doz lipozomal amfoterisin B (L-AMB) 3 mg/kg/gün uygulanmıştır. Hastanın klinik ve laboratuvar bulguları düzelmiş, relaps gelişmemiştir. Sonuç olarak, hekimlerin farkındalığının artması ile VL’de erken tanıya ulaşılabilir. Hastalar gereksiz medikal ya da cerrahi tedaviden korunarak, komplikasyonsuz olarak iyileşebilir.

Anahtar Kelimeler

• visseral leishmaniasis
• sistemik lupus eritematozis
• akut böbrek yetmezliği

A Case of Visceral Leishmaniasis Confused with Lupus Nephritis

Öz

Leismania is an intracellular parasite transmitted to mammals by infected sand flies. There are three clinical forms: cutaneous, visceral and mucocutaneous leishmaniasis. The five key diagnostic features are fever, weight loss, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. These findings may be confused with autoimmune or hematological diseases. Here, a case of visceral leishmaniasis (VL) confused with lupus nephritis diagnosed in a non-endemic region is presented. A 49-year-old male patient was followed up in the regional hospital for a while due to fever, weight loss, hepatosplenomegaly, and pancytopenia. He was referred to our hospital with preliminary diagnoses of hematological malignancy and vasculitis. No signs of malignancy were detected in the patient. Renal and hematological involvement of systemic lupus erythematosus was considered in the patient who developed acute renal failure. Renal histopathology resulted in focal proliferative necrotizing glomerulonephritis. Leishmania spp. PCR and Lesihmania spp IgG were detected positive. With the diagnosis of visceral leishmaniasis, seven doses of liposomal amphotericin B (L-AMB) 3 mg/kg/day were administered. The patient's clinical and laboratory findings improved and no relapse occurred. As a result, early diagnosis of VL can be achieved with increased awareness of physicians. Patients can recover without complications by being protected from unnecessary medical or surgical treatment

Anahtar Kelimeler

• visceral leishmaniasis
• systemic lupus erythematosus
• acute renal failure

Kaynakça

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