获得性免疫缺陷综合征合并内脏利什曼病并发噬血细胞综合征一例

A case of acquired immune deficiency syndrome with visceral leishmaniasis complicated withhemophagocytic syndrome

目的探讨宏基因组学测序(mNGS)在获得性免疫缺陷综合征(AIDS)合并利什曼病诊治中的价值,提高临床对利什曼病的认知及诊疗水平。方法回顾性分析2021年12月28日武汉大学中南医院收治的1例AIDS合并内脏利什曼病(VL)并发噬血细胞综合征患者的临床资料及诊疗经过。结果该患者因发热入院,入院后辅助检查提示外周血粒系、红系、巨核系细胞减少、肝肾功能不全、低纤维蛋白原血症、炎症指标水平明显升高,骨髓细胞学提示噬血现象,常规检查诊断不明确且经验性抗感染治疗无效,送检外周血mNGS检出利什曼原虫序列1262条(杜氏利什曼原虫序列80条,婴儿利什曼原虫20条),最终诊断为AIDS合并内脏利什曼病、噬血细胞综合征,予以葡萄糖酸锑钠(0.6 g/d静脉注射,疗程为10 d)及比克替拉韦/恩曲他滨/丙酚替诺福韦(50 mg/200 mg/25 mg口服)抗HIV治疗后好转出院,院外随访未见复发。结论mNGS具有重要诊断价值,尤其对常规检查诊断不明的AIDS患者。AIDS患者尽早启动HARRT,对改善患者预后、预防VL复发具有重要意义。

Objective To investigate the potential benefits of metagenomics next-generation sequencing(mNGS)on diagnosis for patients with acquired immune deficiency syndrome(AIDS)and Leishmaniasis,and to improve the diagnostic and therapeutic understanding of leishmaniasis.Methods The clinical records,diagnosis and treatment of a patient with AIDS complicated by hemophagocytic syndrome due to visceral leishmaniasis(VL)admitted to Zhongnan Hospital of Wuhan University on December 28th,2021 were reviewed,retrospectively.Results The patient was admitted to hospital presenting with fever.After admission,the laboratory investigations revealed peripheral blood pancytopenia,hepatorenal dysfunction,hypofibrinogenemia and markedly elevated inflammatory markers.Hemophagocytic syndrome was confirmed by bone marrow biopsy.However,no positive pathogens were found after various etiological examinations,and antibiotic therapy was ineffective.Total of 1262 sequences of Leishmania parasites(80 sequences of Leishmania donovani and 20 sequences of Leishmania infantum)were identified from the peripheral blood of the patient through mNGS.Ultimately,a diagnosis of AIDS with concurrent visceral leishmaniasis and hemophagocytic syndrome was established.After sodium antimony gluconate(0.6 g/d,intravenous injection during a course of 10 d)and buctillavir/emtricitabine/propofol tenofovir(50 mg/200 mg/25 mg,oral)for anti-HIV treatment,the patient were improved and discharged,and no recurrence was observed during the followup.Conclusions mNGS is proved to be an effective diagnostic method,especially for patients with HIV/AIDS who cannot be conclusively diagnosed through conventional laboratory tests.HAART at an early stage of AIDS patients is of significant importance for improving the prognosis and preventing the recurrence of VL.