Abstract：
Leishmaniasis is a disease caused by a protozoan and transmitted by sandfly species in several emerging countries. Visceral leishmaniasis is a serious complication, especially in immunosuppressed patients, and is uncommon after liver transplantation. We report the case of a 48-year-old female patient who underwent liver transplantation owing to polycystic liver disease. Six months after the procedure, she was hospitalized with diarrhea, acute kidney failure, and leukopenia. She had been off steroids for 3 months and was taking mycophenolate and tacrolimus. She had already been treated for cytomegalovirus, which was negative on admission. During hospitalization, fever, splenomegaly, ascites, and pancytopenia appeared. Serology for Leishmania by indirect immunofluorescence was negative. Then, bone biopsy and molecular testing for Leishmania diagnosed it as visceral leishmaniasis. Amphotericin therapy was initiated with resolution of fever after 4 days of treatment and gradual recovery from pancytopenia. This case highlights the challenge of early diagnosis of visceral leishmaniasis in liver transplant recipients with diarrhea and leukopenia, which can be caused by immunosuppression or more prevalent viral diseases. Late onset of fever, splenomegaly, and a first negative serologic test also made early diagnosis difficult. The aim of the report is to emphasize the suspicion of visceral leishmaniasis in symptomatic patients from emerging countries and to question the benefit of including protozoan screening in liver transplant donors and recipients in endemic areas.
摘要：
利什曼病是一种由原生动物引起的疾病，在几个新兴国家由沙蝇物种传播。内脏利什曼病是一种严重的并发症，尤其是在免疫抑制患者中，在肝移植后并不常见。我们报告了一名48岁的女性患者，该患者因多囊肝病而接受了肝移植。手术后六个月，她因腹泻住院,急性肾衰竭,和白细胞减少症.她已经停用类固醇3个月，正在服用霉酚酸酯和他克莫司。她已经接受过巨细胞病毒的治疗,入院时是阴性的。住院期间,发烧,脾肿大,腹水,出现了全血细胞减少症。间接免疫荧光检测利什曼原虫血清学阴性。然后，利什曼原虫的骨活检和分子检测诊断为内脏利什曼病。两性霉素治疗开始，治疗4天后发烧消退，全血细胞减少症逐渐恢复。这一病例突出了早期诊断内脏利什曼病在肝移植受者腹泻和白细胞减少的挑战，这可能是由免疫抑制或更普遍的病毒性疾病引起的。迟发性发烧，脾肿大,首次血清学检测阴性也使早期诊断变得困难。该报告的目的是强调新兴国家有症状的患者对内脏利什曼病的怀疑，并质疑在流行地区的肝移植供体和受体中包括原生动物筛查的益处。
