Dalak İnfarktı ve Pentavalan Antimonal Bileşiklere Direnç Gelişen Viseral Leishmaniasis: Olgu Sunumu

Abstract

Visseral leishmaniasis uzamış ateş, splenomegali, hepatomegali, hipergamaglobülinemi, ilerleyici anemi ve pansitopeni ile karakterize protozoal bir enfeksiyondur. Dalak infarktı bu hastalığın seyrinde nadir görülen bir bulgudur. Çalışmada, visseral leishmaniasis tanısı alan ve izlemi sırasında sodyum stiboglukonat tedavisine direnç ve dalak infarktı gelişen dört yaşındaki kız hasta sunuldu. Tedavinin üçüncü gününde sol üst yan ağrısı gelişmesi üzerine çekilen batın ultrasonografi ve bilgisayarlı tomografi tetkikleri ile dalak infarktı saptandı. Tedavinin birinci haftasının sonunda klinik yanıt alınmasına rağmen, yirminci gününde yüksek ateş ile birlikte karaciğer ve dalak boyutlarında artış izlendi. Pentavalan antimonal bileşiğe direnç geliştiği için lipozomal amfoterisin-B tedavisine geçildi ve klinik yanıt alındı. Primer hastalığın tedavisini takiben, dalak infarktı herhangi bir komplikasyon gelişmeksizin birinci ayın sonunda düzeldi. Olgu visseral leishmaniasisin seyrinde ilaç direnci ve dalak infarktı nadir görüldüğü için sunulmuştur.

Keywords

• Dalak infarktı, İlaç direnci, Leishmaniasis, Visseral

Visceral Leishmaniasis with Splenic Infarction and Resistance to Pentavalent Antimonials: A Case Report

Abstract

Visseral leishmaniasis is a protozoan infection that is characterized by a prolonged fever, splenomegaly, hepatomegaly, hypergammaglobulinemia, progressive anemia, and pancytopenia. Splenic infarct is a rare problem, which is seen over the course of this disease. In this study, a four-year-old female patient diagnosed with visceral leishmaniasis who developed resistance to sodium stibogluconate as well as a splenic infarct is presented. Abdominal ultrasonography and computerized tomography, which were used because of the development of left upper abdominal pain on the third day of the treatment, revealed a splenic infarct. Despite the clinical improvement at the end of the first week, enlargement in the liver and the spleen along with high fever were reported on the twentieth day of the treatment. Because of the resistance to pentavalent antimonial drug, amphotericin B liposomal treatment was administered and a positive clinical response was observed. Following the treatment of only the primary disease, the splenic infarct resolved at the end of the first month without any complications. This case is presented as both drug resistance and splenic infarct are rarely seen during the course of visceral leishmaniasis

Keywords

• Splenic infarction, Drug resistance, Leishmaniasis, Visceral

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