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Título: | Unusual endoscopic findings in an immunosuppressed patient |
Autor: | Jiménez García, Victoria Alejandra; Romero Castro, Rafael; Ríos-Martín, Juan José; Argüelles Arias, Federico; Valiente-Méndez, Adoración CSIC; Hergueta-Delgado, Pedro; Caunedo-Álvarez, Ángel | Fecha de publicación: | 27-ene-2021 | Editor: | Georg Thieme Verlag | Citación: | Endoscopy 53: E440-E441 (2021) | Resumen: | Immunosuppressed patients are susceptible to infections by opportunistic agents such as Leishmania that could cause visceral leishmaniasis with gastrointestinal involvement in up to 10 % of cases. We report a 41-year-old man with human immunodeficiency virus (HIV) infection stage C3 with CD4 lymphocytes 81/mm3, 4,070 leukocytes (47.2 % lymphocytes, 0.0 % eosinophils, rest of differential normal) treated with antiretroviral therapy (dolutegravir/abacavir/lamivudine) with good adherence. He also reported mesangiocapillary glomerulonephritis type-1, hepatocutaneous porphyria, and a 7-year history of recurrent visceral leishmaniasis treated with liposomal amphotericin B as secondary prophylaxis. Esophagogastroduodenoscopy and colonoscopy indicated for chronic diarrhea and anemia performed 5 years ago displayed antral erythema, mild nodular appearance in the duodenal mucosa, and normal colonic mucosa. Gastric, duodenal, and colonic biopsies revealed Leishmania spp despite treatment with liposomal amphotericin B. A video capsule endoscopy (VCE) was now indicated for persistent diarrhea. Enteropathy with atrophic and patchy, marked edema of the villus, and whitish nodularity with a “river bedrock” appearance ([Fig. 1 – 3]) in the duodenum and jejunum were identified ([Video 1]). Further gastric and duodenal biopsies showed an accumulation of macrophages in the lamina propria of the mucosa with intracytoplasmatic Leishmania spp ([Fig. 4]). Treatment with meglumine antimoniate was initiated owing to previous failure with liposomal amphotericin B, without response. | Versión del editor: | http://dx.doi.org/10.1055/a-1328-2365 | URI: | http://hdl.handle.net/10261/269850 | DOI: | 10.1055/a-1328-2365 | Identificadores: | doi: 10.1055/a-1328-2365 issn: 0013-726X e-issn: 1438-8812 |
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