Visceralna lajšmanioza kod bolesnice sa ulceroznim kolitisom

  • Goran Janković Klinika za gastroenterologiju i hepatologiju, Klinički centar Srbije, Medicinski fakultet u Beogradu.
  • Lena Martinović Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine
  • Zorica Dakić University of Belgrade, Faculty of Medicine, Department of Microbiology
  • Dragana Mijač Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine
  • Miloš Štulić Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine
  • Miodrag Krstić Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine
DOI: https://doi.org/10.2298/VSP180302076J
Ključne reči: kolitis, ulcerativni;, dijagnoza;, imunosupresivi;, lajšmanioza;, rizik, procena;, serologija

Sažetak


Uvod. Visceralna lajšmanioza je u porastu kod imuno­kom­promitovanih bolesnika zbog povećane dostupnosti imuno­mo­dulatornih lekova. Da bi ukazali na mogućnost postojanja visceralne lajšmanioze kod bolesnika sa zapaljenskom bolesti creva, prikazali smo bolesnicu sa ulceroznim kolitisom lečenu imunosupresivnom terapijom, koja je prethodno boravila u evropskim, mediteranskim zemljama. Prikaz bolesnika. Bolesnica, starosti 29 godina, primljena je u bolnicu sa teškim relapsom ulceroznog kolitisa. Pored dugogodišnje terapije azatioprinom primenjeno je i lečenje kortikosteroidima na koje je dobijen klinički odgovor. U to­ku lečenja bolesnica je bila visokofebrilna sa izraženom he­patosplenomegalijom i pancitopenijom. Dijagnoza lajšmanioze postavljena je serološkim testovima i mikroskopskim nala­zom amastigota u sternalnom punktatu. Na terapiju lipo­zomalnim amfotericinom B dobijen je povoljan odgovor, ali je lečenje moralo biti prekinuto zbog generalizovane urti­ka­rije. Potom je primenjeno lečenje preparatom petovalentnog antimona, ali je i ono moralo biti prekinuto zbog hepato­toksičnosti. S obzirom na to da je kod bolesnice već dobijen terapijski odgovor, dalje lečenje lajšmanioze nije prime­njivano. Na otpustu iz bolnice ulcerozni kolitis je bio u remisiji i nije bilo znakova lajšmanioze. Zaključak. Kod bolesnika sa zapaljenjskom bolesti creva i febrilnošću ne­jas­nog uzroka, koji su prethodno putovali u endemske krajeve, treba razmotriti i postojanje visceralne lajšmanioze u cilju postizanja povoljnog ishoda bolesti.

Biografija autora

Goran Janković, Klinika za gastroenterologiju i hepatologiju, Klinički centar Srbije, Medicinski fakultet u Beogradu.

Profesor interne medicine Medicinskog fakulteta u Beogradu. Načelnik intenzivne nege Klinike za gastroenterologiju i hepatologiju KCS.

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Objavljeno
2021/05/21
Broj časopisa
Vol. 77 Br. 4 (2020): Vojnosanit Pregl
Rubrika
Prikaz bolesnika