Flowers in a bone marrow aspiration

Visceral Leishmaniasis in a Case of Acute Lymphoblastic Leukemia at Both Remission and Relapse, Diagnosed by Bone Marrow Aspiration

“…The incubation period of VL is usually 2 to 4 months, but it can be as long as 10 years and perhaps more. 5 In Iran, kala-azar occurs mainly in infants and children (infantile kala-azar) and shows a seasonal pattern, appearing from April to October with infection having …”

“…It occurs very rarely in adults. 5,6 VL is produced by several species of Leishmania-L donovani, L infantum and L chagasi. Human infection occurs by the bite of the Phlebotomus sandfly and injection of the promastigote form into the subcutaneous tissue.…”

“…7 The human-stage amastigote (LD body) is an obligate intracellular parasite, spherical, 2-5 μm in diameter. 5,6 Cytologically the cytoplasm of a typical LD body contains a nucleus and a kinetoplast. By electron microscope, a LD body shows a double-layer, tubular membrane encasing the organism and oval nucleus with peripheral chromatin, a rod-shaped kinetoplast and a target-shaped basal body; sometimes a segment of flagellum is visible.…”

“…[1][2][3][4] Typical symptoms of VL are fever, pallor and hepatosplenomegaly, \and since hematologic findings usually reveal pancytopenia, leukemia must always be considered; however, other differential diagnoses are other infectious diseases or any other causes of fever of unknown origin. 5,6 Since our patient lived in an endemic area for VL and VL is an opportunistic infection in immunosuppressed patients, VL should be considered in such cases. This parasitic infection may arise in patients with leukemia as a transfusiontransmitted infection or as a consequence of the activation of a latent infection because of immunosuppression resulting from both ALL and its treatment or as a new infection, as occurs in nonleukemic subjects.…”