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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.

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A bone marrow smear showing macrophages containing numerous Leishmania amastigotes (May-Grunwald/Giemsa stain, ×100).
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Figure 2: A bone marrow smear showing macrophages containing numerous Leishmania amastigotes (May-Grunwald/Giemsa stain, ×100).

Mentions: The bone marrow smears revealed macrophages with numerous Leishmania amastigotes (Fig. 2). The bone marrow biopsy also showed Leishmania parasites within macrophages. The amastigote tissue forms were seen when her liver biopsy was re-evaluated (Fig. 3). Leishmania IgG was found positive at a 1/1,280 titer in her serum specimen by indirect immunofluorescent assay. High dose (4 mg/kg/day) intravenous liposomal amphotericin B was given on days 1 to 5 and 10, 17, 24, 31, and 38 days [10]. Then, her fever resolved, and general conditions greatly improved with the exception of neutropenia. After a dose of granulocyte colony-stimulating factor, her neutrophil count also reached to a normal level. No other complications were observed in the duration of the treatment.


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 bone marrow smear showing macrophages containing numerous Leishmania amastigotes (May-Grunwald/Giemsa stain, ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: A bone marrow smear showing macrophages containing numerous Leishmania amastigotes (May-Grunwald/Giemsa stain, ×100).
Mentions: The bone marrow smears revealed macrophages with numerous Leishmania amastigotes (Fig. 2). The bone marrow biopsy also showed Leishmania parasites within macrophages. The amastigote tissue forms were seen when her liver biopsy was re-evaluated (Fig. 3). Leishmania IgG was found positive at a 1/1,280 titer in her serum specimen by indirect immunofluorescent assay. High dose (4 mg/kg/day) intravenous liposomal amphotericin B was given on days 1 to 5 and 10, 17, 24, 31, and 38 days [10]. Then, her fever resolved, and general conditions greatly improved with the exception of neutropenia. After a dose of granulocyte colony-stimulating factor, her neutrophil count also reached to a normal level. No other complications were observed in the duration of the treatment.

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