Abstract:

A woman aged 55 years was admitted to Department of Hematology, Shaanxi Nuclear Industry 215 Hospital on April 17, 2024 because of abnormal blood cell parameters for more than 9 months. Multiple routine blood tests showed progressive reductions of blood cells, with the lowest white blood cell count of 1.4 × 10⁹/L, hemoglobin levels of 90 g/L, and platelet levels of 90 × 10⁹/L. The patient was given intermittently cell-boosting treatments with Diyushengbai tablets and granulocyte colony stimulating factors, resulting in difficulty in maintaining white blood cell counts. The case had worked outdoors for a long period of time, and complained of mosquito and sandfly bites. Admission physical examinations showed a body temperature of 37 ℃, blood pressure of 73/43 mmHg (1 mmHg = 0.133 kPa), poor mental health, facial appearance of chronic diseases and soybean-sized scabs and scales scattered on the skin. CT shows slightly enlarged liver, enlarged spleen, widened portal vein, and enlarged spleen. Bone marrow aspiration revealed delayed maturation of megakaryocytes, hypochromic anemia of small cells, and detection of Leishmania-Donovan body in macrophages. Bone marrow biopsy showed phagocytosis of phagocytic cells containing parasites or microorganisms. Metagenomics capture (MetaCAP) pathogen detection showed that the sequence number of L. infantis was 371 554, and the sequence number of Aspergillus niger was 86 880. The diagnosis was visceral leishmaniasis with A. niger infection. Following administer sodium antimony gluconate (6 ml/d) in combination with light shielded pump administration of amphotericin B cholesterol sulfate complex (50 mg/d) for treatment for two weeks, the case had improved symptoms and was discharged from hospital. One-month follow-up showed that routine blood tests returned to normal, and no other remarkable abnormalities.

Key words: Visceral leishmaniasis, Metagenomic next-generation sequencing, Pathogen macro-capture technology, Infectious diseases