[Visceral leishmaniasis and bronchial asthma: influence of steroid therapy in the development of the macrophage activation syndrome and relative adrenal insufficiency].
The risk of suffering opportunistics infections in the immunoincompetent patient is a fact perfectly established. An uncommon situation constitutes the bronchopaties, pathologies with a high prevalence among the general population that they require habitually, among other, steroid treatment. The immunosupression confers to the clinical evolution of the infections, as a consequence of the inadequate response to the physical stress, due to the inhibition of the hypothalamus-hypophysis axis being able to in particularly serious cases, to develop the denominated macrophage activation syndrome, a serious and uncommon syndrome that darkens the clinical prognosis in these patients. In presence of a feverish syndrome of uncertain origin in a patient in immunosuppressor treatment, although it is to low dose, it is necessary to carry out a exhaustive differential diagnosis, should consider, among them, the infection for Leishmania, a parasitosis whose incidence is increasing notably in the last years in the immunosuppressed population. We present the clinical case of a 63 year-old patient, immunoincompetent as a consequence of secondary chronic steroid therapy to asthmatic bronchopaty that experiences an uncommon form of visceral leishmaniasis in our area, consistent in multiorganic failure in the context of the development of a macrophage activation syndrome.
Ruiz Ginés
M A
MA
Servicio de Análisis Clínicos y Bioquímica, Hospital Universitario de La Princesa, Madrid. mangelrg@sescam.jccm.es
Ruiz Ginés
J A
JA
Menéndez Gómez
J L
JL
Pérez Cogolludo
A M
AM
Domínguez Martín
S
S
Fernández Rodríguez
E
E
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000209:etiology*; D001249:Asthma / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000175:diagnosis; D055501:Macrophage Activation Syndrome / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012772:Shock, Septic / Q000175:diagnosis / Q000209:etiology*
D000305:Adrenal Cortex Hormones