一名41岁的男子出现呕吐和大便。他有长期间歇性发热的病史,一般性皮肤色素沉着过度,左下软骨的拖动感觉和无意的体重减轻。自2010年以来,他一直在接受抗逆转录病毒联合治疗以治疗HIV感染。他还接受了结核性脊柱炎的抗结核治疗。住院期间,他被发现有姿势性低血压,低血糖,低钠血症,高钾血症,全血细胞减少症,甲状腺功能减退,高球蛋白血症和低白蛋白血症与血清白蛋白/球蛋白比值逆转。在Synacthen测试后,早晨血浆皮质醇低于正常水平,无法适当刺激。骨髓组织病理学提示内脏利什曼病。他被诊断为内脏利什曼病和HIV合并感染原发性肾上腺功能不全(Addison病)和原发性甲状腺功能减退症,作为一个罕见的和不寻常的介绍。
A 41-year-old man presented with vomiting and loose stools. He had a history of long-term intermittent fever, generalised skin hyperpigmentation, dragging sensation in the left hypochondrium and unintentional weight loss. He was receiving combination antiretroviral therapy since 2010 for HIV infection. He also received antitubercular therapy for tuberculous spondylitis. During the hospital stay, he was found to have postural hypotension, hypoglycaemia, hyponatraemia, hyperkalaemia, pancytopenia, hypothyroidism, hyperglobulinaemia and hypoalbuminaemia with reversal of serum albumin/globulin ratio. The morning plasma cortisol was lower than normal and could not be appropriately stimulated after the Synacthen test. The bone marrow histopathology was suggestive of visceral leishmaniasis. He was diagnosed as a
case of visceral leishmaniasis and HIV coinfection with primary adrenal insufficiency (Addison\'s disease) and primary hypothyroidism, as a rare and unusual presentation.