Visceral leishmaniasis mimicking systemic lupus erythematosus

Bueno, Greyce Christine Lisboa; Koerich, Amanda Terra de Sá; Burg, Luciana Bonnassis; Kretzer, Sara Letícia; Moral, Joanita Angela Gonzaga Del; Pereira, Ivânio Alves

doi:10.1590/0037-8682-0208-2018

Cited by 6 publications

(8 citation statements)

References 7 publications

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“…Other misdiagnosed cases have been reported. 8,9 In addition, clinical cases of VL were misdiagnosed as other rheumatic diseases, including rheumatoid arthritis and autoimmune hepatitis. In one study, ANA was detected in five of six VL patients, and anti-dsDNA antibodies were present in one patient, antismooth muscle antibodies in four patients, RF in four patients, and anticardiolipin antibodies in one patient.…”

Section: Discussionmentioning

confidence: 99%

“…We summarize some key points of differential diagnosis between VL and SLE in Table 3. [8][9][10] After infection, even if the patient is asymptomatic or clinically cured, the infection can persist and reactivate in the setting of immunosuppression. Normally, innate and cell-mediated immune responses are activated to clear Leishmania.…”

Section: Discussionmentioning

confidence: 99%

“…These differential points were summarized according to References[8][9][10]. Abbreviations: HLH, hemophagocytic lymphohistiocytosis; SLE, systemic lupus erythematosus; VL, visceral leishmaniasis.…”

mentioning

confidence: 99%

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A rare case of visceral leishmaniasis misdiagnosed as systemic lupus erythematosus

Zheng

Liu

Wang

et al. 2021

Rheumatology & Autoimmunity

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Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania donovani and transmitted by sandflies. It can be life-threatening if not treated. Common clinical features of VL include recurrent fever, pancytopenia, splenomegaly, and a variety of positive autoantibodies, which can lead to a misdiagnosis of systemic lupus erythematosus (SLE). We report the case of a 25-year-old woman with VL misdiagnosed as SLE to add to the existing literature on this subject.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A rare case of visceral leishmaniasis misdiagnosed as systemic lupus erythematosus

Zheng

Liu

Wang

et al. 2021

Rheumatology & Autoimmunity

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“…Without treatment, VL can lead to a high fatality rate (2). Some laboratory features of VL, including cytopenia, hypergammaglobulinemia, and the presence of antinuclear antibodies (ANA), can resemble the laboratory features of some autoimmune diseases, especially systemic lupus erythematosus (SLE) (3)(4)(5)(6)(7)(8). Although the exact immunological mechanisms related to VL is still not fully understood, the crosstalk between innate and adaptive immune systems and the type of the cell-mediated responses elicited play an important role in the disease progression (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Autoimmune manifestations of visceral leishmaniasis in Chinese patients

Chen¹,

Zhou²,

Liu³

et al. 2021

Ann Palliat Med

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Background: Visceral leishmaniasis (VL) is a rare, parasitic infection with distinctive features that may mimic autoimmune diseases. In this study, we report on the laboratory autoimmune manifestations of VL in Chinese patients.Methods: Twenty-seven patients who were hospitalized with VL were included in this retrospective study.Routine blood and biochemical tests were conducted, and a variety of autoimmune antibodies and complement fractions were detected. Continuous variables are expressed as means ± standard deviations, and categorical data are expressed as a number (percentage). Missing data were not included for statistical analysis. Data were analyzed with SPSS v. 13.0 statistical software.Results: All patients had cytopenia (82% with pancytopenia) and hepatosplenomegaly, and 25 (93%) patients also suffered from fever. The prevalence of autoantibodies (number of patients with antibody detected/total number of patients tested for the antibody) for each antibody tested was as follows: antinuclear antibodies (ANA; 18/22, 82%), anti-neutrophil cytoplasmic antibodies (ANCA; 4/5, 80%), anti-mitochondrial M2 antibodies (AMA-M2; 1/6, 17%), anti-liver cytosol specific type 1 antibodies (anti-LC1; 1/6, 17%), anti-liver/kidney microsomal type 1 antibodies (anti-LKM1; 1/6, 17%), anti-centromere protein-B antibodies (anti-CENP-B; 4/21, 19%), anti-Sjögren's syndrome type A antibodies (anti-SSA; 2/21, 10%), anti-Sjögren's syndrome type B antibodies (anti-SSB; 1/21, 5%), anti-Jo-1 antibodies (1/21, 5%), antidouble-stranded DNA antibodies (anti-dsDNA; 1/25, 4%), direct antiglobulin test (direct Coombs; 6/6, 100%), and rheumatoid factor (RF; 3/11, 27%). Increased serum C-reactive protein (CRP) was found in 14 (100%) patients. Of the 19 patients tested for serum IgG, 17 patients (89%) were found with increased IgG levels, while complement 3 protein (C3) and complement 4 protein (C4) levels were not decreased in any of the 19 patients. Of note, in one patient followed up 1 month after therapy, only ANA was still present, and all the other laboratory autoimmune manifestations had disappeared.Conclusions: VL infection associated with laboratory autoimmune manifestations is common. This may lead to patients with VL being misdiagnosed as having an autoimmune disorder. An obligatory differential diagnosis that considers VL should be undertaken for patients diagnosed with systemic lupus erythematosus (SLE), especially in endemic areas, is necessary.

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“…The disease is an important threat for public health in the tropical and semitropical regions of the world (Chaouch et al 2019;Maritati et al 2018;Masoori et al 2018;Moreira et al 2019). This infectious disease are reported throughout 98 countries worldwide, which is caused spectrum of manifestation including cutaneous to systemic disease (Bueno et al 2019;Chaouch et al 2019;Hezari et al 2016;Sosa et al 2019;Toepp et al 2019). This tropical parasitic infection has several major clinical forms including cutaneous, visceral, and mucocutaneous leishmaniasis (Behniafar et al 2019).…”

Section: Introductionmentioning

confidence: 99%

Arginase/nitric oxide modifications using live non-pathogenic Leishmania tarentolae as an effective delivery system inside the mammalian macrophages

2020

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Recombinant live delivery system based on chemokine IFN-c-inducible protein-10 kDa (CXCL 10 or IP-10), as a suitable immunotherapy tool, have been used for the treatment of Leishmania infections. This chemokine can defeat Leishmania spp. infection via producing nitric oxide (NO) for parasite killing. This study was performed to investigate the effects of IP-10 on the infected human macrophages by L. tarentolae expressing IP-10. We also quantified the arginase activity and NO production in the co-cultured human macrophages with L. tarentolae expressing IP-10 as compared with wild L. tarentolae. The results elucidate that in the infected cells with L. tarentolae expression of IP-10 the arginase activity decreased, and inversely, NO production intensely increased. Altogether, L. tarentolae expressing IP-10 shows a favorable therapeutic tool to improve the treatment of Leishmania infection. This work suggests that L. tarentolae expressing IP-10 cause specific effects on the metabolic pathways of the macrophage host, which might enable the host cells in killing of parasites and decreasing the survival of them against Leishmania infection.

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Visceral leishmaniasis mimicking systemic lupus erythematosus

Cited by 6 publications

References 7 publications

A rare case of visceral leishmaniasis misdiagnosed as systemic lupus erythematosus

A rare case of visceral leishmaniasis misdiagnosed as systemic lupus erythematosus

Autoimmune manifestations of visceral leishmaniasis in Chinese patients

Arginase/nitric oxide modifications using live non-pathogenic Leishmania tarentolae as an effective delivery system inside the mammalian macrophages

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