Visceral leishmaniasis associated with macrophage activation syndrome: Case report and literature review

IDCases

Abdelilah Berhili¹  Mounia Slaoui²  Rachid Seddik²  Chaymae Rochdi²  Mohammed Bensalah²  Jalila El Malki²  Imane El Mezgueldi³  Ali Azghar³  Oumaima Nassiri³  Boutaina Mouhoub³  Noufissa Benajiba³  Achraf Miri³ 

[1] Corresponding author at: Central Laboratory, University Hospital Center Mohamed VI Oujda, Morocco.;Faculty of Medicine and Pharmacy Oujda, Mohammed First University Oujda, Morocco;Central Laboratory, University Hospital Center Mohamed VI Oujda, Morocco;

关键词: Visceral leishmaniasis;    Macrophage activation syndrome;    Sand flies;    Protozoa parasite;    Morocco;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: The combination of visceral leishmaniasis (VL) and macrophage activation syndrome (MAS) makes the diagnosis difficult due to their similar clinical presentation, with a poor prognosis especially since the treatment is still poorly codified.We report the case of a 17-month-old female patient from Berkane, presenting for a 3 months history of anarchic fever with anemic syndrome made up of pallor and hemorrhagic syndrome made up of epistaxis. Physical examination revealed a temperature of 39 ° C, lower limbsedema, paleness of skin and mucous membranes, gingival petechiae, bleached hair, and hepatosplenomegaly. Case presentation: The complete blood count showed pancytopenia with deep aregenerative normochromic normocytic anemia at 3 g/dL, leukocytes were at 4860/mm 3 with neutropenia at 680/mm 3 and thrombocytopenia at 12.000/mm3, the blood smear was without abnormality. These anomalies were associated with a hypoalbunemia, hypertriglyceridemia, hyperferritinemia, lactate dehydrogenase (LDH) level was at 337 IU/L, low prothrombin time (PT) at 56 % and fibrinogen level at 1 g/L. The direct Coombs test was positive. Examination of the myelogram revealed the presence of leishmania bodies and figures of hemophagocytosis. A diagnosis of visceral leishmaniasis associated with MAS was made.The patient was put on liposomal amphotericin B and corticosteroid therapy with good clinical and biological evolution and good therapeutic tolerance. Conclusion: The association of VL and MAS remains rare and should be evoked even in non-endemic areas since late diagnosis worsens the prognosis and may even be responsible for the death of patients despite an aggressive treatment.

【 授权许可】

Unknown