Sepsisähnliches Krankheitsbild bei Immunsuppression nach früherem Mallorcaurlaub

Abstract

In immunosuppressed patients, a high rate of complications due to opportunistic infection is known. We report the case of a 36 year old patient with ulcerative colitis and a septic complication with ongoing pancytopenia. Due to colonic perforation, colectomy had to be performed. Despite this intervention, the septic constellation persisted. The pancytopenia in peripheral blood counts also persisted with the necessity of repetitive transfusions. A bone marrow biopsy showed an infiltration with Leishmania bodies in macrophages. Tissue culture allowed for typing of the parasites as belonging to the L. donovani/infantum complex, DNA sequencing confirmed infection with L. infantum. This infection must have been contracted during a vacation on Mallorca about 1.5 years earlier. Administration of liposomal amphotericin B cured the patient. Surprisingly, histological examination of the resected colon reveiled the presence of an immunoblastic B-cell lymphoma. In this case, immunosuppression was a prerequisite for the manifestation of leishmaniosis.

Ulcerative Colitis and Microorganisms

“…Visceral leishmaniasis is a zoonosis rare in Western Europe, but life-threatening in immunocompromised patients. The course of infection depends on the type of the patient's immune reaction; patients with Th 1 response often present an asymptomatic or oligo-symptomatic disease, and after recovery they are immune to re-infection (Badaró et al, 1986;Hagenah et al, 2007). The disease can relapse after treatment in immunocompromised patients.…”

Hohes Fieber, Panzytopenie und Splenomegalie 8 Monate nach einem Mallorca-Urlaub

“…Fallberichte zur VL sind im deutschsprachigen Raum in den vergangenen Jahren mehrfach publiziert worden [5,6,14,17,18,24]. Ergänzend dazu soll die vorliegende Kasuistik unterstreichen, dass auch beliebte Reiseziele wie die Insel Mallorca mit klassischen "Tropenkrankheiten" wie der VL assoziiert werden müssen.…”