ÖZ
Romatizmal hastalıklar, çoklu organ tutulumu ve çeşitli laboratuvar anomalileri ile karakterize, kompleks sistemik bozukluklardır. Tanısal yaklaşım, klinik bulguların ve serolojik belirteçlerin kapsamlı bir şekilde değerlendirilmesi ve diğer romatizmal hastalıklar ve sistemik enfeksiyonlar gibi benzer özelikler gösteren durumların dışlanmasını içerir. Visseral leyişmanyaz (VL), öncelikle retiküloendotelyal sistemi etkileyen bir protozoon enfeksiyonudur. Retiküloendotelyal sisteme parazit infiltrasyonunun doğrudan etkileri, ardından gelen konakçı immün tepkisi ile birleştiğinde, sistemik lupus eritematozus (SLE) ve romatoid artriti (RA) taklit eden klinik ve laboratuvar bulguları üretir. Ayrıca, VL hastalarının bir alt grubunda gözlemlenen abartılı immün yanıt, klinik olarak primer hemofagositik lenfohistiyositoz (HLH) ve makrofaj aktivasyon sendromu (MAS) ile örtüşmektedir. VL, SLE ve Felty sendromunun klinik bir taklitçisi olarak hareket eder ve ikincil HLH için tetikleyici görevi görebilir. Ayrıca, endemik bölgelerde VL, SLE ve RA hastalarında sıklıkla hastalık alevlenmelerini taklit eden bir durum olarak ortaya çıkabilir. İmmünosüpresif tedaviler alan bu hassas hasta gruplarında gecikmiş tanı, VL’nin klinik seyrini ve prognozunu önemli ölçüde kötüleştirebilir. Bu derlemede, VL’nin klinik ve immünolojik belirtilerini açıklanmış, HLH, MAS, SLE ve Felty sendromu ile örtüşen tanısal özellikleri hakkında ayrıntılı, karşılaştırmalı bir değerlendirme yapılmıştır.
Anahtar Kelimeler:
Visseral leyişmanyaz, romatizmal hastalıklar, hemofagositik lenfohistiyositoz, sistemik lupus eritematozus, romatoid artrit
Kaynaklar
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