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2020, Número 3

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Rev Cubana Med Trop 2020; 72 (3)


Linfohistiocitosis hemofagocítica asociada con leishmaniasis visceral. Revisión de casos reportados

Garrido D, Fuseau M, Garrido S, Celi S

Idioma: Ingles.
Referencias bibliográficas: 40
Paginas: 1-16
Archivo PDF: 459.97 Kb.


RESUMEN

Introducción: La leishmaniasis es una enfermedad tropical y subtropical con una elevada incidencia, dos millones de casos nuevos por año y 500 000 de leishmaniasis visceral. La linfohistiocitosis hemofagocítica es una complicación grave y rara de la leishmaniasis visceral.
Objetivo: Describir las características clínicas de la linfohistiocitosis hemofagocítica asociada con leishmaniasis visceral.
Métodos: Se realizó una revisión bibliográfica basada en los informes de casos indexados en MEDLINE/PubMed. Se identificaron 34 publicaciones; después de analizarlas en función de los criterios de inclusión se trabajó con 22 trabajos.
Resultados: En los trabajos incluidos se informaron 25 casos; el 52 % fueron pacientes menores de 2 años. Todos presentaron esplenomegalia y 84 % hepatomegalia. Se describieron citopenias en todos los pacientes: 100 % trombocitopenia, 96 % anemia y 84 % leucopenia o neutropenia. Se encontró hipertrigliceridemia e hipofibrinogenemia en 68 % y 32 %, respectivamente, e hiperferritinemia en 80 %. Todos los pacientes fueron tratados contra leishmania, 80 % con anfotericina B liposomal. Las complicaciones incluyeron: hemorragia gastrointestinal, coagulación intravascular diseminada, anemia hemolítica autoinmune, falla multiorgánica/shock séptico, erupción petequial y cuatro pacientes fallecieron.
Conclusiones: En la leishmaniasis visceral, el síndrome hemofagocítico es una afección poco frecuente que afecta principalmente a pacientes pediátricos. Para el tratamiento, usando la anfotericina B liposomal se obtienen excelentes resultados; sin embargo, la evidencia es insuficiente para hacer una recomendación.


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