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Visceral leishmaniasis with endobronchial involvement in an immunocompetent adult.

Kotsifas K, Metaxas E, Koutsouvelis I, Skoutelis A, Kara P, Tatsis G - Case Rep Med (2011)

Bottom Line: Leishmania amastigotes were also found on bone marrow and liver biopsies.Treatment with IV Amphotericin B was successful.In conclusion, cough should not be overlooked as a presenting symptom of visceral leishmaniasis and may be a sign of pulmonary involvement.

View Article: PubMed Central - PubMed

Affiliation: Pulmonary Medicine Department, Evaggelismos General Hospital, 45-47 Ypsilantou Street, 10676 Athens, Greece.

ABSTRACT
Visceral leishmaniasis is characterized by fever, cachexia, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Cough may be a presenting symptom as well. However, pulmonary involvement is considered rare and mainly described in immunocompromised patients. We describe a case of an immunocompetent adult whose clinical presentation was dominated by cough and hemoptysis. Bronchoscopy revealed a discreet polypoid mucosal endobronchial lesion whose biopsy yielded Leishmania amastigotes within histiocytes. Transbronchial needle biopsy of a right paratracheal lymph node was also positive. Leishmania amastigotes were also found on bone marrow and liver biopsies. Treatment with IV Amphotericin B was successful. In conclusion, cough should not be overlooked as a presenting symptom of visceral leishmaniasis and may be a sign of pulmonary involvement.

No MeSH data available.


Related in: MedlinePlus

Transbronchial needle biopsy of a mediastinal lymph node showing histiocytes containing abundant Leishmania amastigotes (H-E × 1000). Insert shows a close-up view of an amastigote. Its ovoid shape, eccentric nucleus, and kinetoplast are discerned.
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fig3: Transbronchial needle biopsy of a mediastinal lymph node showing histiocytes containing abundant Leishmania amastigotes (H-E × 1000). Insert shows a close-up view of an amastigote. Its ovoid shape, eccentric nucleus, and kinetoplast are discerned.

Mentions: On bronchoscopy, epistaxis and pharyngeal inflammation consistent with candidiasis were noticed. There was mild diffuse redness throughout the tracheobronchial tree. Inflammation was more prominent on the medial aspect of the bronchus intermedius extending into the middle lobe bronchus. Interestingly, a discreet mucosal polypoid lesion was observed on the middle lobe carina (Figure 1). Bronchial biopsies taken from this lesion revealed epithelial hyperplasia and several Leishmania amastigotes within histiocytes (Figures 2(a) and 2(b)). Transbronchial needle biopsies (TBNB) targeted at the right lower paratracheal lymph node also revealed histiocytes containing abundant Leishmania amastigotes (Figure 3).


Visceral leishmaniasis with endobronchial involvement in an immunocompetent adult.

Kotsifas K, Metaxas E, Koutsouvelis I, Skoutelis A, Kara P, Tatsis G - Case Rep Med (2011)

Transbronchial needle biopsy of a mediastinal lymph node showing histiocytes containing abundant Leishmania amastigotes (H-E × 1000). Insert shows a close-up view of an amastigote. Its ovoid shape, eccentric nucleus, and kinetoplast are discerned.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3090634&req=5

fig3: Transbronchial needle biopsy of a mediastinal lymph node showing histiocytes containing abundant Leishmania amastigotes (H-E × 1000). Insert shows a close-up view of an amastigote. Its ovoid shape, eccentric nucleus, and kinetoplast are discerned.
Mentions: On bronchoscopy, epistaxis and pharyngeal inflammation consistent with candidiasis were noticed. There was mild diffuse redness throughout the tracheobronchial tree. Inflammation was more prominent on the medial aspect of the bronchus intermedius extending into the middle lobe bronchus. Interestingly, a discreet mucosal polypoid lesion was observed on the middle lobe carina (Figure 1). Bronchial biopsies taken from this lesion revealed epithelial hyperplasia and several Leishmania amastigotes within histiocytes (Figures 2(a) and 2(b)). Transbronchial needle biopsies (TBNB) targeted at the right lower paratracheal lymph node also revealed histiocytes containing abundant Leishmania amastigotes (Figure 3).

Bottom Line: Leishmania amastigotes were also found on bone marrow and liver biopsies.Treatment with IV Amphotericin B was successful.In conclusion, cough should not be overlooked as a presenting symptom of visceral leishmaniasis and may be a sign of pulmonary involvement.

View Article: PubMed Central - PubMed

Affiliation: Pulmonary Medicine Department, Evaggelismos General Hospital, 45-47 Ypsilantou Street, 10676 Athens, Greece.

ABSTRACT
Visceral leishmaniasis is characterized by fever, cachexia, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Cough may be a presenting symptom as well. However, pulmonary involvement is considered rare and mainly described in immunocompromised patients. We describe a case of an immunocompetent adult whose clinical presentation was dominated by cough and hemoptysis. Bronchoscopy revealed a discreet polypoid mucosal endobronchial lesion whose biopsy yielded Leishmania amastigotes within histiocytes. Transbronchial needle biopsy of a right paratracheal lymph node was also positive. Leishmania amastigotes were also found on bone marrow and liver biopsies. Treatment with IV Amphotericin B was successful. In conclusion, cough should not be overlooked as a presenting symptom of visceral leishmaniasis and may be a sign of pulmonary involvement.

No MeSH data available.


Related in: MedlinePlus