Leishmaniasis cutánea difusa en un paciente con sida

Carlos Pérez, Yoanet Solías, Gerzaín Rodríguez, .

Palabras clave: leishmaniasis, leishmaniasis cutánea difusa, síndrome de inmunodeficiencia adquirida, infecciones oportunistas relacionadas con sida, diagnóstico diferencial, inmunosupresión

Resumen

Objetivo. Estudiar un paciente con leishmaniasis cutánea difusa y sida y comentar el tema.
Materiales y métodos. Soldado de 29 años, procedente de San José del Guaviare, con pérdida de 18 kilos de peso en los últimos 10 meses y erupción generalizada de dos meses de evolución. El Elisa y el Western blot fueron positivos para virus de inmunodeficiencia humana. Tenía 92 LT CD4/mm3. Presentaba máculas, pápulas y placas eritematoescamosas, psoriasiformes y generalizadas, cuyas biopsias demostraron abundantes microorganismos fagocitados por macrófagos, que se teñían de negro con la coloración de Gomory. Se diagnosticó histoplasmosis diseminada. Se inició tratamiento antirretroviral y antimicótico con itraconazol sin observar mejoría.
Resultados. La anfotericina B produjo mejoría, pero las lesiones recidivaron más numerosas y nodulares con compromiso oral. Once meses después del comienzo de su enfermedad, nuevas biopsias de piel y la revisión de las anteriores confirmaron que el paciente tenía leishmaniasis cutánea difusa. El cultivo no permitió aislar el parásito. La miltefosina produjo mejoría importante. Las pápulas y máculas recidivaron varios meses después; recibió 52 ampollas de glucantime® durante dos meses, consiguiéndose la curación clínica, situación que permanece dos años y medio después de iniciada la enfermedad.
Conclusiones. La leishmaniasis cutánea difusa debe plantear sospecha de sida. El tratamiento es difícil; debe ser antirretroviral y antileishmaniásico, con profilaxis antiparasitaria. Los amastigotes de Leishmania no son positivos con la coloración de Gomory en técnicas controladas; se diferencian del histoplasma por morfología, cultivo, inmunohistoquímica, anticuerpos específicos y reacción en cadena de la polimerasa. La asociación leishmaniasissida es beneficiosa para ambos gérmenes; es posible el aumento de casos en Colombia por el auge de ambas entidades.

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  • Carlos Pérez Departamentos de Medicina Interna y Servicio de Dermatología, Hospital Militar Central, Bogotá D.C., Colombia
  • Yoanet Solías Departamentos de Medicina Interna y Servicio de Dermatología, Hospital Militar Central, Bogotá D.C., Colombia
  • Gerzaín Rodríguez Departamento de Patología y Laboratorio de Biología Molecular de las Micobacterias, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca, Colombia

Citas

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Cómo citar
Pérez, C., Solías, Y., & Rodríguez, G. (2006). Leishmaniasis cutánea difusa en un paciente con sida. Biomédica, 26(4), 485-97. https://doi.org/10.7705/biomedica.v26i4.314

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Publicado
2006-12-01
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Presentación de caso