المؤلفون: Sarah May Johnson, Alasdair Bamford, Kimberly Gilmour, Sujith Samarasinghe

المصدر: BMJ Case Rep

مصطلحات موضوعية: Male, Pediatrics, medicine.medical_specialty, Fever, medicine.medical_treatment, Antiprotozoal Agents, Unusual Association of Diseases/Symptoms, 030204 cardiovascular system & hematology, Polymerase Chain Reaction, Dexamethasone, Lymphohistiocytosis, Hemophagocytic, Sepsis, 03 medical and health sciences, Broad spectrum, 0302 clinical medicine, Bone marrow aspirate, 030225 pediatrics, Amphotericin B, medicine, Humans, Glucocorticoids, Travel, business.industry, Infant, Immunosuppression, General Medicine, medicine.disease, Pancytopenia, United Kingdom, Empirical treatment, Visceral leishmaniasis, Spain, Leishmaniasis, Visceral, Liposomal amphotericin, business

الوصف: A 4-month-old male infant presented acutely unwell with fever. He was initially treated for sepsis but failed to improve with IV broad spectrum antibiotics. Haemophagocytic lymphohistiocytosis (HLH) was diagnosed due to his fever, pancytopenia, splenomegaly, hypertriglyceridaemia, hypofibrinogenaemia and significant hyperferritinaemia. An array of differentials for HLH including both immunological and infectious causes were considered and excluded. He had travelled to Madrid, and hence visceral leishmaniasis (VL) was suspected, but was not confirmed on the initial bone marrow aspirate (BMA) microscopy or culture. He improved with empirical treatment with dexamethasone and liposomal amphotericin B. VL was later confirmed on BMA PCR. He made a good recovery and remained well at 12 month follow-up. Non-endemic countries need rapid and sensitive VL diagnostics. A thorough travel history and high clinical index of suspicion are necessary to avoid the pitfall of treatment with intense immunosuppression recommended in treatment guidelines for HLH.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f9fae54bba9b0b481466b1dc54a1a569
https://europepmc.org/articles/PMC6626435/