Focal spleen lesions in visceral leishmaniasis, a neglected manifestation of a neglected disease: report of three cases and systematic review of literature

Rinaldi, Francesca; Giachè, Susanna; Spinicci, Michele; Corsi, Paola; Ambu, Silvia; Gianfaldoni, Giacomo; Rigacci, Luigi; Arena, Umberto; Bartoloni, Alessandro; Zammarchi, Lorenzo

doi:10.1007/s15010-019-01279-5

Cited by 19 publications

(14 citation statements)

References 34 publications

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“…Although VL is seen in both genders, most of our cases were men, similar to the previous studies (15,16,(24)(25)(26). Since men live outdoor more than women, they are exposed to phlebotomine sand flies which is a vector that causes VL transmission (25).…”

Section: Discussionsupporting

confidence: 86%

“…Ultrasonography, CT and MRI detect multiple hypoechoic/hypodense nodules in the spleen. However, these images are non-specific and can be detected in septic emboli or abscesses, splenic infarction, metastatic disease, lymphoma, and granulomatous inflammatory diseases such as mycobacterial, fungal infections, cat-scratch disease, and sarcoidosis, as well as VL (6,(8)(9)(10)16). Most of our patients (7/10 patients) had multiple hypodense nodules in the spleen in which the parenchyma was usually homogeneous.…”

Section: Conflict Of Interestmentioning

confidence: 80%

“…Especially in one of our two patients who died, there were 90 days between the hospital admission and the diagnosis. Sometimes, an unnecessary splenectomy can be performed because of delayed diagnosis or misdiagnosis in patients with VL like as in our seventh patient (16). Sepsis, pneumonia, and jaundice are frequently concomitant with VL, especially in patients who have high parasitemia (17).…”

Section: Discussionmentioning

confidence: 93%

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Multiple Nodular Lesions in Spleen and Liver in Visceral Leishmaniasis

Kutlu

Herek

et al. 2019

Infect Dis Clin Microbiol

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Objective:We aimed to describe the clinical, laboratory, and radiological characteristics of visceral leishmaniasis (VL) in our region to find additional clues that can help diagnosis. Materials and Methods:All the patients with VL who admitted to our clinic between January 2010 and January 2018 were reviewed retrospectively. The patients with symptoms and signs suggestive of VL and a positive indirect fluorescent antibody test (IFA) or rapid diagnostic test, and/or direct parasitology consisting of the presence of amastigotes of Leishmania in bone marrow aspirate were included in the study. We collected the demographic and clinical features, laboratory, and radiological information from the hospital database. Results:We present ten (seven males and three females) cases of VL, with the mean age of 53 (range of 31-75). Serological tests such as IFA or rapid diagnostic tests were positive in all patients. Amastigotes of Leishmania were present in only three of eight patients who underwent bone marrow biopsy. Abdominal magnetic resonance imaging or computed tomography revealed that all patients (10/10) had splenomegaly, eight of 10 patients had hepatomegaly, and seven patients had intraabdominal lymphadenopathy. Seven patients had multiple hypodense nodular lesions in the spleen with homogeneous parenchyma. Two patients had nodular lesions in the liver. Two patients died because of multiorgan failure before completing their treatment. The remaining patients completed liposomal amphotericin B treatment and cured.Conclusion: VL should be suspected in the diagnosis of the patients, who had long-term fever, splenomegaly, pancytopenia associated with multiple nodular lesions in the spleen with/without liver involvement.

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Section: Discussionsupporting

confidence: 86%

Section: Conflict Of Interestmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 93%

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Multiple Nodular Lesions in Spleen and Liver in Visceral Leishmaniasis

Kutlu

Herek

et al. 2019

Infect Dis Clin Microbiol

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“…The remaining nine cases were simply described as an increased metabolism in the spleen [9][10][11][12][13][14][15][16] or an uptake compatible with lymphoma. 17 In the other cases, the FDG uptake in the spleen was described as "homogeneous" in one case, 18 "diffuse" in 19 cases, 7,[19][20][21][22][23] "diffuse and multifocal" in 10 cases, 5,7,22,24 "nodular" in two cases, 25,26 "patchy and granular" in one case, 27 and "with subcortical uptake" in one case. 28 The pattern of the uptake was variable, and information was not always available in the cases reported in literature.…”

Section: Resultsmentioning

confidence: 97%

“…Another technique currently accepted is DNA detection through the PCR method in tissue samples. 4 Imaging modalities are rarely used in the diagnosis of VL, and there are experiences with findings in ultrasonography, computerized tomography (CT), and magnetic resonance imaging, 5,6 but there is little information regarding fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in VL, especially in IS patients. 7 The aim of our study was to describe the FDG-PET/CT findings in patients with VL in our institution and those found in a systematic literature review.…”

Section: Introductionmentioning

confidence: 99%

Utility of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Visceral Leishmaniasis: Case Report and Literature Review

Pinnegar

Sánchez-Montalvà

Profitós

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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The diagnosis of visceral leishmaniasis (VL) is complicated and often unsuspected. Little is known of the usefulness of nuclear imaging in VL. Our objective was to describe findings seen in fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in cases of VL. We retrospectively reviewed VL cases diagnosed at Vall d’Hebron University Hospital from May 2012 to May 2018 and selected those that had an FDG-PET/CT performed. Information on procedures and details of the FDG-PET/CT features and follow-up were collected. We then systematically reviewed the literature on VL and FDG-PET/CT. Four of 43 patients diagnosed with VL had an FDG-PET/CT performed. All four patients presented diffuse splenic uptake of FDG-PET/CT. Adenopathy was not always present, and bone marrow uptake was found in two patients. A posttreatment FDG-PET/CT in one patient revealed normalization of initial findings. In the literature review, 43 of 50 cases presented similar splenic uptake in the PET/CT, being described as different patterns: “increased metabolism,” “homogeneous,” “diffuse,” “diffuse and multifocal,” “nodular,” “patchy and granular,” “subcortical,” and “compatible with lymphoma.” Other frequent findings were bone marrow uptake and adenopathies. We, therefore, conclude that FDG-PET/CT could become a useful tool for the diagnosis and follow-up of VL and that VL should be taken into account in patients with fever of unknown origin with enhanced splenic uptake in FDG-PET/CT. Differential diagnosis in these cases should be made with splenic primary lymphoma, virus infections, chemotherapy, and colony-stimulating factor therapy. Further structured studies with more cases are needed to define its diagnostic and prognostic value.

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Viszerale Leishmaniose

Wilhelm¹

2019

Chirurg

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Focal spleen lesions in visceral leishmaniasis, a neglected manifestation of a neglected disease: report of three cases and systematic review of literature

Cited by 19 publications

References 34 publications

Multiple Nodular Lesions in Spleen and Liver in Visceral Leishmaniasis

Multiple Nodular Lesions in Spleen and Liver in Visceral Leishmaniasis

Utility of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Visceral Leishmaniasis: Case Report and Literature Review

Viszerale Leishmaniose

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