Imported visceral leishmaniasis – unexpected bone marrow diagnosis in a patient with fever, pancytopenia, and splenomegaly

American Journal of Blood Research

Valentina Gallina¹  Christian J Wiedermann¹  Günter Weiss¹  Mohsen Farsad¹  Arber Golemi¹  Raffaella Binazzi¹ 

关键词: Immunocompetent;    imported;    visceral leishmaniasis;    imaging;    hypersplenism;   

DOI  :  

学科分类：血液学

来源: e-Century Publishing Corporation

【 摘 要 】

Leishmaniasis is spreading from mediterranean countries to the north of Europe. The Alps are not an endemic region and there are only few reports of sporadic cases. We report the case of a 72 year old male who presented after a syncope with fever, cough and a sacral skin rash. Clinical examination revealed splenomegaly, elevated liver enzymes and pancytopenia; differential diagnosis included myeloproliferative or lymphoproliferative disorders, infections and auto-immune conditions that cause enlargement of the spleen and liver diseases, however, all tests were negative. In ¹⁸FDG PET computerized tomography, pathological and diffuse uptake in the spleen was seen, with mild and homogeneous FDG uptake in the bone marrow and normal tracer uptake elsewhere in the body. Bone marrow aspiration revealed the presence of numerous intra- and extracellular Leishmania amastigotes. Travel history indicated that he had been in Sardinia for a 7-day vacation several months ago. The patient promptly responded to treatment with liposomal amphotericin B. Imported visceral leishmaniasis is likely to be seen more frequently in non-endemic regions and fever, pancytopenia and splenomegaly are diagnostic clues, whereas diagnostic confirmation may be done by detection of Leishmania spp. amastigotes in the bone marrow.

【 授权许可】

Unknown