A Case of Visceral Leishmaniasis Characterized by Fever of Unknown Origin and Nodular Lesions in the Spleen

Yıl 2024, Cilt: 34 Sayı: 3

Yakup Gezer Erol Handemir Arzu Tarakçı Muhammet Rıdvan Tayşi A Basturk Salih Cırık

https://doi.org/10.54005/geneltip.1406185

Öz

Introduction: Leishmaniasis is a zoonosis caused by Leishmania spp. parasites through the bite of infected female sandflies and has three main forms: visceral (VL), cutaneous (CL) and mucocutaneous (MCL). VL is endemic in many countries around the world. It is on the World Health Organisation's (WHO) list of neglected diseases and is difficult to diagnose due to its non-specific clinical manifestations. VL is characterised by fever, hepatosplenomegaly and bone marrow suppression. The diagnosis is made by the presence of amastigotes in tissue or blood samples or serological and DNA-based techniques.
Case: Our patient was a 30-year-old male did not have any immunodeficiency. He was characterised by persistent fever, pancytopenia, hepatosplenomegaly and multiple millimetric hypoechoic solid nodules in the spleen. The diagnosis of VL was confirmed using all three parasitological, serological and molecular methods. Cure was achieved by treatment with liposomal amphotericin B (L-AmB).
Discussion: VL should be considered in the differential diagnosis of patients with fever of unknown cause, pancytopenia and hepatosplenomegaly. The presence of solid nodular lesions in the spleen may also shed light in favour of VL

Anahtar Kelimeler

Fever of unknown cause, hepatosplenomegaly, pancytopenia, splenic nodule, visceral leishmaniasis

Nedeni Bilinmeyen Ateş ve Dalakta Nodüler Lezyonlar ile Karakterize Bir Visseral Leishmaniasis Olgusu

Öz

Giriş: Leishmaniasis, enfekte dişi tatarcık sineklerinin ısırması sonucu Leishmania spp. parazitlerinin neden olduğu bir zoonoz olup visseral (VL), kutanöz (KL) ve mukokutanöz (MKL) olmak üzere üç ana formu vardır. VL dünyada birçok ülkede endemik olarak bulunur. Dünya Sağlık Örgütü’nün (DSÖ) dikkat çektiği ihmal edilen hastalıklar listesinde olup, spesifik olmayan klinik bulguları nedeniyle tanı konulması zor bir hastalıktır. VL ateş, hepatosplenomegali, kemik iliği süpresyonu ile seyreder. Tanı doku ya da kan örneklerinde amastigotların görülmesi veya serolojik ve DNA esaslı teknikler ile konur.
Olgu: 30 yaşında erkek hasta herhangi bir immünyetmezliği yoktu. Persistan ateş, pansitopeni, hepatosplenomegali ve aynı zamanda dalakta çok sayıda milimetrik hipoekoik solid nodüller ile karakterizeydi. Parazitolojik, serolojik ve moleküler yöntemlerin üçü de kullanılarak VL tanısı kesinleştirildi. Lipozomal amfoterisin B (L-AmB) ile tedavi edilerek kür sağlandı.
Tartışma: Nedeni bilinmeyen ateş, pansitopeni ve hepatosplenomegali olan hastalarda ayırıcı tanıda VL düşünülmelidir. Dalakta solid nodüler lezyonların varlığı da VL lehine ışık tutabilir.

Anahtar Kelimeler

Dalakta nodül, hepatosplenomegali, nedeni bilinmeyen ateş, pansitopeni, visseral leishmaniasis

Kaynakça

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