Hüseyin GÜLEN, Ayşen TÜREDİ YILDIRIM, Yeşim YİĞİT, Serkan BAŞTEMİR, Fatih DÜZGÜN, Ahmet ÖZBİLGİN

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

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.

Anahtar Kelimeler:

Dalak infarktı, İlaç direnci, Leishmaniasis, Visseral

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

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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Murray HW, Berman JD, Davies CR, Saravia NG. Advances in leishmaniasis. Lancet 2005;366:1561-77.
Alvar J, Velez ID, Bern C, Herrero M, Desjeux P, Cano J, et al. Leishmaniasis worldwide and global estimates of its incidence. PLoS One 2012;7:e35671.
Agrawal S, Rai M, Sundar S. Management of visceral leishmaniasis: Indian perspective. J Postgrad Med 2005;51 Suppl 1:S53-7.
Celestini A, Paglia F, Dell’ Unto O, Guarisco R, Puoti C. Rare splenic complications and specifi c serology: Decisive diagnostic tools in two cases of visceral leishmaniasis. Italian Journal of Medicine 2011;5:274-7.
Singh BJ, Kumar A. Splenic infarctions in mixed infection with kala azar and falciparum malaria. J Assoc Physicians India 1991;39:293.
Lydakis C, Basta M, Siafakas NM, Schiza S. Asymptomatic spleen infarctions in a patient with visceral Leishmaniasis. European Journal of Radiology Extra 2003;46:50-2.
Cinquetti G, Banal F, Rondel C, Plancade D, de Saint Roman C, Adriamanantena D, et al. Splenic infarction during Plasmodium ovale acute malaria: First case reported. Malar J 2010; 9:288.
Kim A, Park YK, Lee JS, Chung MH, Kim ES. A case of symptom- atic splenic infarction in vivax malaria. Korean J Parasitol 2007;45: 55-8.
Jaroch MT, Broughan TA, Hermann RE. The natural history of splenic infarction. Surgery 1986;100:743–50.
Alvar J, Croft S, Olliaro P. Chemotherapy in the treatment and control of leishmaniasis. Adv Parasitol 2006;61:223-74.
Croft SL, Sundar S, Fairlamb AH. Drug resistance in Leishmaniasis. Clin Microbiol Rev 2006;19:111-26.
Petrela R, Kuneshka L, Foto E, Zavalani F, Gradoni L. Pediatric visceral leishmaniasis in Albania: A retrospective analysis of 1,210 consecutive hospitalized patients (1995–2009). PLoS Negl Trop Dis 2010;4:e814.
Thakur CP, Narayan S, Ranjan A. Epidemiological, clinical & pharmacological study of antimony-resistant visceral leishmaniasis in Bihar, India. Indian J Med Res 2004;120:166-72.
Bodhe PV, Kotwani RN, Kirodian BG, Pathare AV, Pandey AK, Thakur CP, et al. Dose-ranging studies on liposomal amphotericin B (L-AMP-LRC-1) in the treatment of visceral leishmaniasis. Trans