Multiple Nodular Lesions in Spleen and Liver in Visceral Leishmaniasis

Abstract

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.

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

“…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.…”

“…In 27 cases, enhanced uptake was seen in the bone marrow. Of these, five cases were IS patients, 9,20,21,24,25 20 cases were in immunocompetent patients, 7,14,15,18,22,23,26,29 and in two cases, the immune state was unknown. 19,27 Bone marrow biopsy revealed Leishmania spp.…”

“…in three non-IS patients. 14,15,18 Of the remaining cases with enhanced bone marrow uptake, three biopsies were negative 22,23,29 and 14 cases did not undergo bone marrow biopsy or had no information available. 7,26 Lymph node involvement was only mentioned in 13 cases (five IS [8][9][10]21,24 and eight non-IS 7,16,28 ).…”

“…Enhanced bone marrow metabolism was seen in 29 cases (six IS cases, 21 non-IS, and two immune status unknown). 7,9,14,15,[18][19][20][21][22][23][24][25][26][27]29 Of these, four resulted in a negative biopsy for Leishmania spp., 19,22,23,29 one was not biopsied, 26 and 11 cases were positive, 9,14,15,18,20,21,24,25,27 with six cases being IS, four cases non-IS, and one unknown. In the remaining 13 cases, biopsy was not specified.…”

“…7 Interestingly, 13 cases showed no bone marrow uptake but had a positive bone marrow aspiration. 5,[10][11][12][13]16,17,20,22,30,31 In oncology, studies have shown that the extent of FDG uptake in neoplasms is positively correlated with the number of malignant cells, and there is a higher biopsy yield in the most enhanced areas. 34 We therefore infer that enhanced bone marrow uptake could correlate with a higher parasitic replication rate and increase the diagnostic yield of bone marrow biopsies.…”