Localized Lymphadenopathy Due to Leishmanial Infection

Abstract

A 25-year-old female patient presented with an isolated cervical lymph node enlargement several months after having returned from Spain and Latin America. She had no other signs or symptoms of disease. Leishmania infantum/chagasi was identified as the causative agent. With extended travel activities localized lymph node enlargement due to leishmanial infection should be included in the differential diagnosis of lymphadenopathy of unknown origin.

Atypical presentation in adults in the largest community outbreak of leishmaniasis in Europe (Fuenlabrada, Spain)

“…However, concerns about a change of immunocompetence and parasite dissemination exist. Previous LLL cases had been treated as VL [5,6,8,9]. In one patient, we found dissemination to several lymphadenopathy locations and splenomegaly, although we think this was a true case of VL because of anemia and splenomegaly.…”

“…In contrast, fever, splenomegaly and pancytopenia were present in more than 90% of the typical VL cases, and as expected, this combination of findings was the most frequent form of presentation [1]. We should include LLL in the differential diagnosis of any isolated lymphadenopathy, at least in areas endemic for leishmaniasis, such as Spain and the Mediterranean basin; diagnosis is easy with FNAC [5][6][7][8][9]. Serology is not useful in CL because most patients have negative results [1].…”

“…We diagnosed a substantial number of cases of LLL, an atypical presentation that has rarely been reported in the literature [5][6][7][8][9]. To our knowledge, this is the first series of cases of LLL caused by L. infantum, and we compared it to VL during the outbreak.…”

“…In previous case reports, LLL was supposed to be treated like the visceral form, but treatment was diverse: treated but drug not reported [9], antimonial therapy [6], LAB but dose not reported [8], LAB 10 mg/kg per day [7] and LAB 30 mg/kg total dose [5]. We found that clinical characteristics, diagnostic profile and evolution of LLL seem to be closer to CL than to typical VL, and we have documented spontaneous clinical resolution of lymphadenopathies without treatment in one patient.…”

“…Nevertheless, in the Mediterranean area, isolated cases of an infrequent form of leishmaniasis involving isolated lymphadenopathies without fever or skin lesions have been described in a few case reports as localized leishmanial lymphadenopathy (LLL) [5][6][7][8][9]. The clinical management of LLL is not well defined because it is not a classic form of VL or CL [5,8].…”