患者，女，38岁，山西省临汾市乡宁县人，农民。2016年诊断肾病综合征，2021年诊断为系统性红斑狼疮。2024年10月反复发热就诊于风湿免疫科，化验示全血细胞三系减少、白蛋白球蛋白比例倒置、免疫球蛋白IgG升高、凝血异常、心磷脂抗体阳性、脾大等，痰真菌培养示白假丝酵母菌感染。患者10月29日胸部CT示双肺散在炎症，伴右下叶空洞形成。10月31日行骨髓穿刺，骨髓象示巨核细胞1个，整片分布血小板，全髓涂片可见利什曼原虫无鞭毛体（利杜小体），遂转入感染病科。11月5日血清送至山西省疾病预防控制中心，内脏利什曼病rK39免疫层析试纸检测阳性。11月6日骨髓病原微生物宏基因组二代测序（mNGS）检出利什曼原虫属DNA序列数66 596条，其中婴儿利什曼原虫序列数1 668条，相对丰度为52.02%。予持续吸氧、输注去白悬浮红细胞、抗感染、补液、纠正低蛋白血症、止血等对症治疗，11月4日予两性霉素B胆固醇硫酸酯复合物50 mg静脉泵入；11月5日调整为100 mg；11月6日再调整为150 mg（足剂量）。患者不适症状逐渐缓解后出院。12月9日复查，抗原虫疗效佳，未查见利杜小体，肺部空洞消失。随访，患者未再复发。

The patient was a 38-year-old female farmer from Xiangning County, Linfen City, Shanxi Province. She was diagnosed with nephrotic syndrome in 2016 and systemic lupus erythematosus in 2021. In October 2024, the patient was admitted to the Department of Rheumatology and Immunology due to recurrent fever. Laboratory tests revealed pancytopenia, inverted albumin-globulin ratio, elevated IgG levels, coagulation abnormalities, positive anticardiolipin antibodies and splenomegaly, and sputum fungal cultures indicated Candida albicans infection. Chest CT scans on October 29 showed scattered inflammation in bilateral lungs with cavity formation in the right lower lobe. On October 31, bone marrow punctures displayed one megakaryocyte and widespread platelet distribution in blood marrow smears, and Leishmania amastigotes (Leishman-Donovan bodies) were observed across whole bone marrow smears, prompting patient’s transfer to the Department of Infectious Diseases. On November 5, serum samples were sent to Shanxi Provincial Center for Disease Control and Prevention, where the rK39 rapid immunochromatographic test yielded a positive result. On November 6, metagenomic next-generation sequencing (mNGS) of bone marrows detected 66 596 Leishmania species DNA sequences, including 1 668 L. infantum sequences with relative abundance of 52.02%. Symptomatic treatments were therefore given, including continuous oxygen therapy, transfusion of leukoreduced red blood cells, anti-infection therapy, fluid replacement, correction of hypoalbuminemia, and hemostasis. On November 4, amphotericin B cholesterol sulfate complex was administered intravenously at 50 mg via an intravenous pump, and the dose was adjusted to 100 mg on November 5 and further escalated to the 150 mg (full dose) on November 6. The patient was discharged after the discomfort symptoms gradually subsided. A follow-up examination on December 9 showed excellent antiprotozoal efficacy, with no Leishmania amastigotes detected and the pulmonary cavities disappeared. Subsequent follow-ups indicated no recurrence in the patient.