Özet:

Mr. Editor, Hatice Köse and Ark. have read with interest the presentation of the fact entitled "A Adult Vascular Leishmaniazis Fact:Thank and Treatment Options: Fact Presentation" published in the second edition of 2018 of the Cağdaş Medical Journal (Cağdaş Medical Journal 2018;8(2);165-167) and published in the second edition of 2018 of the Cağdaş Medical Journal. This presentation of the fact in our country is a valuable trick in the direction of emphasizing the memory of visera leishmaniazis in patients with fever, pansitopenia and hepatosplenomegaly. We also want to summarize the need to be cautious in the case of the lieshmania hepatitis, which we have previously observed in the Child Gastroenterology, Hepatology and Nutrition Unit of the Faculty of Medicine of the University of Inönü, with the aim of emphasizing that we may be cautious in children with symptoms such as extended fever, abdominal swelling, impotence, appetite, hepatosplenomegaly, leukopen, trombocytopenia and hepatitis. The three-year-old male patient appealed to our clinic with complaints of impairedness, appetite, fever and abdominal swelling that lasted for about five months. In the physical examination of the patient, not characterized by the history of life, the general condition was treated in medium, pleasant, skin color breathing, heart rhythm, breathing sounds natural, under the liver coat 8 cm and hard, under the wing coat 10 cm, and the neurological examination was normal. In the full blood count WBC:3,5 (103/M), HGB:9.3 g/dL, PLT:129 (103/M), INR:1, the total protein in biochemistry: 7.9 g/dL, albumin: 3.2 g/dL, total bilirun: 0.7 mg/dL AST: 127 U/L, ALT 94 U/L. In the abdominal USG, the liver is 9 cm large, in the homogeneous parankimic ecosis, and the contours were monitored regularly. Intrahepatic pathways were monitored normally. The main portal of the veins and hepatic veins and branches were normal. Dalak kraniokaudal was 10 cm large, in a homogeneous parankim structure and the contours were regular. In the dynamic BT, the liver craniokaudal is 2 cm large, the contours in the homogeneous parankim structure are monitored regularly. Hepatic and portal venus were monitored normally. Portal ven and splenic ven are ectatic. The pancreate was monitored in the monitored cuts in the homogeneous parankimic structure and in normal size. It was that the dalak is 14.5 cm (SM) size, in a homogeneous parankim structure. The patient with pansitopenia was made a bone marrow and leishmania was observed in the bone marrow (Figure 1). The patient was initiated with 10-20 mg/kg/g glucantim containing antimone. At the end of three weeks there is still no clinical improvement, 3 mg/kg of liposomal amphotericin B 0. 1 . 2nd and 3. In the 4th and 10th days, the total dose was administered at 18 mg/kg, a single dose per day [2]. There were no side effects. The clinical and laboratory values were corrected and the patient was deported to be traced by foot. The patient's splenomegaly improved after 6 months. The main reservoir of viral leishmaniasis, a zoonotic infection, are dogs and spiders. In acute initial illness, the high fever, appetite, insufficiency, breathing and stomach swelling are among the causes of application. Physical examinationThe discovery is the wave size that can reach advanced dimensions. In our country, in childhood leishmaniasis studies, hepatosplenomegali was found at 97.-99% and respiration at 50-99%. Therefore, it should be considered VL especially if there is fever in patients with splenomegaly in front of the hepatic table. In some cases, it should not be forgotten that splenomegalin will improve over a long time after treatment.