输入性内脏利什曼病误诊误治致多器官衰竭合并噬血细胞综合征病例分析OA

Objective To investigate the diagnosis and treatment process of visceral leishmaniasis(VL)misdiagnosed and mismanaged leading to multiple organ failure(MOF)combined with hemophagocytic lymphohistiocytosis(HLH),to analyze the effectiveness and safety of using conventional Amphotericin B for treatment under multiple dilemmas,so as to provide reference for the diagnosis and treatment of diseases similar to VL in clinical practice.Methods A retrospective analysis was conducted on the clinical data of a patient diagnosed and treated in March 2023 for splenomegaly,who was misdiagnosed and mistreated,and was ultimately confirmed to have imported VL combined with HLH and MOF.Results The patient presented with splenomegaly as the initial symptom and sought medical treatment repeatedly.Later,due to abdominal distension,accompanied by breathing difficulties and unexplained fever,the patient was diagnosed with hypersplenism,autoimmune liver disease,and pancytopenia.Without a clear cause identified,the patient underwent splenic artery embolization to cause splenic infarction,and the condition further deteriorated to MOF.After inquiries about the epidemiological history,bone marrow puncture,peripheral blood examination,and multidisciplinary consultation,it was diagnosed as imported VL combined with HLH and MOF.The misdiagnosis period was 2 months.The patient was successfully treated with a gradual dose-escalation regimen of conventional Amphotericin B,was discharged after recovery.Follow-up for 2 years showed no recurrence.Conclusion For patients with unexplained splenomegaly,a detailed epidemiological history should be taken,early etiological examinations should be performed,and regular follow-up should be ensured to avoid misdiagnosis and mistreatment.In the clinical treatment of VL and patients with related complications,a gradual dose-escalation regimen of conventional Amphotericin B can be used as the preferred scheme,with definite efficacy,controllable adverse reactions,and good clinical value.