Leishmaniasis visceral y asma bronquial: influencia del tratamiento esteroideo en el desarrollo del síndrome de activación macrofágica e insuficiencia suprarrenal relativa / Visceral leishmaniasis and bronchial asthma: influence of steroid therapy in the development of the macrophage activation syndrome and relative adrenal insufficiency

El riesgo de padecer infecciones oportunistas en los pacientes inmunodeprimidos es un hecho perfectamente establecido. Una situación infrecuente la constituyen las broncopatías, patologías con un elevada prevalencia entre la población general, que requieren habitualmente, entre otros, tratamiento esteroideo. La inmunodepresión confiere a la evolución clínica de las infecciones, una inadecuada respuesta al estrés físico, debido a la inhibición del eje hipotálamo-hipofisario, pudiendo en casos particularmente graves, desarrollar el denominado Síndrome de Activación Macrofágica, síndrome grave e infrecuente, que ensombrece el pronóstico clínico en estos pacientes. Ante un síndrome febril de origen incierto en un paciente en tratamiento inmunosupresor, aunque sea a dosis bajas, es necesario realizar un exhaustivo diagnóstico diferencial, debiendo considerar, entre ellos, la infección por Leishmania, una parasitosis cuya incidencia se está incrementando notablemente en los últimos años entre la población inmunodeprimida. Se presenta el caso clínico de un paciente de 63 años de edad, inmunocomprometido a consecuencia de terapia crónica esteroide a secundaria a broncopatía asmática, que experimenta una forma infrecuente de leishmaniasis visceral en nuestro medio, consistente en fracaso multiorgánico a raíz del desarrollo de un Síndrome de Activación Macrofágica

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 beingable 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 inimmunosuppressor 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 ofthe development of a macrophage activation syndrome

[Visceral leishmaniasis and bronchial asthma: influence of steroid therapy in the development of the macrophage activation syndrome and relative adrenal insufficiency]. / Leishmaniasis visceral y asma bronquial: influencia del tratamiento esteroideo en el desarrollo del síndrome de activación macrofágica e insuficiencia suprarrenal relativa.

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.