Limits...
Visceral leishmaniasis mimicking autoimmune hepatitis, primary biliary cirrhosis, and systemic lupus erythematosus overlap.

Tunccan OG, Tufan A, Telli G, Akyürek N, Pamukçuoğlu M, Yılmaz G, Hızel K - Korean J. Parasitol. (2012)

Bottom Line: In addition to typical clinical findings as fever, hepatosplenomegaly, and cachexia, VL is associated with autoimmune phenomena.To date, VL mimicking or exacerbating various autoimmune diseases have been described, including systemic lupus erythematosus (SLE), rheumatoid arthritis, and autoimmune hepatitis (AIH).Herein, we presented a patient with VL who had overlapping clinical features with SLE, AIH, as well as antimitochondrial antibody (AMA-M2) positive primary biliary cirrhosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Microbiology and Infectious Diseases, Gazi University Hospital Besevler, 06500 Ankara, Turkey. oguzel@gazi.edu.tr

ABSTRACT
Visceral leishmaniasis (VL) is a life-threatening infection caused by Leishmania species. In addition to typical clinical findings as fever, hepatosplenomegaly, and cachexia, VL is associated with autoimmune phenomena. To date, VL mimicking or exacerbating various autoimmune diseases have been described, including systemic lupus erythematosus (SLE), rheumatoid arthritis, and autoimmune hepatitis (AIH). Herein, we presented a patient with VL who had overlapping clinical features with SLE, AIH, as well as antimitochondrial antibody (AMA-M2) positive primary biliary cirrhosis.

Show MeSH

Related in: MedlinePlus

(A) Indirect cholestatic features with lobular confluent necrosis (H&E stain, ×200). (B) Plasma cells as a dominant component of inflammation in the liver (MGP, ×400)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3375451&req=5

Figure 1: (A) Indirect cholestatic features with lobular confluent necrosis (H&E stain, ×200). (B) Plasma cells as a dominant component of inflammation in the liver (MGP, ×400)

Mentions: A 26-year-old female patient referred to the rheumatology department with complaints of anorexia, malaise, weight loss, joint swelling, and low grade fever. She was living in a Mediterranean region of Turkey. Her past history was notable for photosensitivity, oral ulcers, and possible thalassemia trait. On admission, her physical examination was significant for erythema and symmetrical arthritis at ankles, wrists, and hand joints. The spleen was palpated 10 cm below the costal margin, and the liver had a longitudinal size of 15 cm. Erythrocyst sedimentation rate (ESR) and C- reactive protein was 65 and 19.9 mg/L, respectively. Complete blood count revealed hemoglobin 10.2 gr/dl, mean corpuscular volume 69 fl, leukocyte 4,000/mm3, and platelet 157,000/mm3. Other pertinent laboratory data was as follows: creatinine 0.7 mg/dl (Normal=0.5-1.2), alanine aminotransferase 46 U/L (ALT, Normal<40), aspartate aminotransferase 51 U/L (AST, Normal<40), alkaline phosphatase 67 U/L (ALP, N=53-141), gama-glutamyl transferase 17 U/L (GGT, N=0-50), albumin 3.2 g/dl, globulin 6.9 g/dl, and lactate dehydrogenase 236 U/L (N=125-243). Her laboratory investigation was positive for anti-nuclear antibody immunofluorescence (ANA-IFA), anti-smooth muscle antibody (ASMA), and Coombs tests on previous referral center. Repeated ANA was strongly positive as well as antimitochondrial (AMA-M2) antibodies and Coombs tests. Rheumatoid factor (RF) was 123 IU/ml (N<20). Liver kidney microsomal (anti-LKM), anti-cytosolic liver (LC-1), antisoluble liver/liver-pancreas (SLA/LP), ASMA, anti-ENA, ds-DNA tests were negative. Serum C3 and C4 were within normal limits. IgG was 5,810 mg/dl (N=751-1,560) with a polyclonal pattern. A liver biopsy was performed to rule out autoimmune hepatitis. Histological examination of the liver biopsy revealed robust plasma cell and lymphocyte infiltrations in the sinusoidal areas, and periductal and portal small granuloma formation. Histochemically, plasma cells, which were stained for Methyl Grün Pyronine (MGP), were found to act as a dominant feature among the inflammatory infiltrates in the liver. This finding also supported and raised the suspicion of autoimmune hepatitis-PBC overlap (Fig. 1A, B).


Visceral leishmaniasis mimicking autoimmune hepatitis, primary biliary cirrhosis, and systemic lupus erythematosus overlap.

Tunccan OG, Tufan A, Telli G, Akyürek N, Pamukçuoğlu M, Yılmaz G, Hızel K - Korean J. Parasitol. (2012)

(A) Indirect cholestatic features with lobular confluent necrosis (H&E stain, ×200). (B) Plasma cells as a dominant component of inflammation in the liver (MGP, ×400)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3375451&req=5

Figure 1: (A) Indirect cholestatic features with lobular confluent necrosis (H&E stain, ×200). (B) Plasma cells as a dominant component of inflammation in the liver (MGP, ×400)
Mentions: A 26-year-old female patient referred to the rheumatology department with complaints of anorexia, malaise, weight loss, joint swelling, and low grade fever. She was living in a Mediterranean region of Turkey. Her past history was notable for photosensitivity, oral ulcers, and possible thalassemia trait. On admission, her physical examination was significant for erythema and symmetrical arthritis at ankles, wrists, and hand joints. The spleen was palpated 10 cm below the costal margin, and the liver had a longitudinal size of 15 cm. Erythrocyst sedimentation rate (ESR) and C- reactive protein was 65 and 19.9 mg/L, respectively. Complete blood count revealed hemoglobin 10.2 gr/dl, mean corpuscular volume 69 fl, leukocyte 4,000/mm3, and platelet 157,000/mm3. Other pertinent laboratory data was as follows: creatinine 0.7 mg/dl (Normal=0.5-1.2), alanine aminotransferase 46 U/L (ALT, Normal<40), aspartate aminotransferase 51 U/L (AST, Normal<40), alkaline phosphatase 67 U/L (ALP, N=53-141), gama-glutamyl transferase 17 U/L (GGT, N=0-50), albumin 3.2 g/dl, globulin 6.9 g/dl, and lactate dehydrogenase 236 U/L (N=125-243). Her laboratory investigation was positive for anti-nuclear antibody immunofluorescence (ANA-IFA), anti-smooth muscle antibody (ASMA), and Coombs tests on previous referral center. Repeated ANA was strongly positive as well as antimitochondrial (AMA-M2) antibodies and Coombs tests. Rheumatoid factor (RF) was 123 IU/ml (N<20). Liver kidney microsomal (anti-LKM), anti-cytosolic liver (LC-1), antisoluble liver/liver-pancreas (SLA/LP), ASMA, anti-ENA, ds-DNA tests were negative. Serum C3 and C4 were within normal limits. IgG was 5,810 mg/dl (N=751-1,560) with a polyclonal pattern. A liver biopsy was performed to rule out autoimmune hepatitis. Histological examination of the liver biopsy revealed robust plasma cell and lymphocyte infiltrations in the sinusoidal areas, and periductal and portal small granuloma formation. Histochemically, plasma cells, which were stained for Methyl Grün Pyronine (MGP), were found to act as a dominant feature among the inflammatory infiltrates in the liver. This finding also supported and raised the suspicion of autoimmune hepatitis-PBC overlap (Fig. 1A, B).

Bottom Line: In addition to typical clinical findings as fever, hepatosplenomegaly, and cachexia, VL is associated with autoimmune phenomena.To date, VL mimicking or exacerbating various autoimmune diseases have been described, including systemic lupus erythematosus (SLE), rheumatoid arthritis, and autoimmune hepatitis (AIH).Herein, we presented a patient with VL who had overlapping clinical features with SLE, AIH, as well as antimitochondrial antibody (AMA-M2) positive primary biliary cirrhosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Microbiology and Infectious Diseases, Gazi University Hospital Besevler, 06500 Ankara, Turkey. oguzel@gazi.edu.tr

ABSTRACT
Visceral leishmaniasis (VL) is a life-threatening infection caused by Leishmania species. In addition to typical clinical findings as fever, hepatosplenomegaly, and cachexia, VL is associated with autoimmune phenomena. To date, VL mimicking or exacerbating various autoimmune diseases have been described, including systemic lupus erythematosus (SLE), rheumatoid arthritis, and autoimmune hepatitis (AIH). Herein, we presented a patient with VL who had overlapping clinical features with SLE, AIH, as well as antimitochondrial antibody (AMA-M2) positive primary biliary cirrhosis.

Show MeSH
Related in: MedlinePlus