Visceral leishmaniasis in a patient with systemic lupus erythematosus

Abstract

Visceral leishmaniasis is an infection with an insidious and disabling course caused by parasites of the genus Leishmania. In Europe, it is mostly associated with HIV infection. Systemic lupus erythematosus and its treatment are associated with increased risk of infection, neoplastic and concomitant autoimmune disorders. The association of these diseases may go unnoticed.A 60 year-old Caucasian woman with lupus presented with a one-year history of fever, malaise, weakness and weight loss. The highlights on physical examination were pallor, palpable hepatosplenomegaly and low-grade fever. Blood tests showed pancytopenia, hyperproteinemia with hypoalbuminemia and hypergammaglobulinemia; electrophoresis showed a polyclonal gamma curve. Full-body CT scan revealed massive hepatosplenomegaly. Microbiology investigation was negative for the most common pathogens, including tuberculosis. There were no signs of hematologic malignancy in the bone marrow smear. PCR for Leishmania infantum was positive both in blood and bone marrow. The patient was treated with liposomal amphotericin B, and immunosuppression was adjusted. She showed rapid clinical improvement and 6 months later had no signs of disease.The differential diagnosis in a patient with lupus presenting with fever and multisystemic manifestations includes infectious or neoplastic disorders. The patient lived in an endemic area of Leishmania, and typical clinical and analytical changes were all present, making this case highly educational. The case highlights the importance of a patient's epidemiological background and how it can lead to the diagnosis and timely treatment of a rare disease.

Visceral leishmaniasis in a patient with systemic lupus erythematosus: Dilemma in diagnosis and management

“…In the systematic literature review by Santana et al reported in 2015, there were 10 cases in which SLE and VL coexisted and mimicked SLE exacerbation, and 18 cases in which VL led to false suspicion of SLE. The only case from Turkey in this review is a VL case mimicking SLE by Tunccan et al 1,11 In our literature review, we found several more case reports, one from Turkey (the second case reported from Turkey is also a VL case mimicking SLE) 12–15 . In other words, although Turkey is among the endemic countries for leishmaniasis, the case presented here is the first reported case of VL in a lupus patient in Turkey.…”

“…case from Turkey in this review is a VL case mimicking SLE by Tunccan et al 1,11 In our literature review, we found several more case reports, one from Turkey (the second case reported from Turkey is also a VL case mimicking SLE). [12][13][14][15] In other words, although Turkey is among the endemic countries for leishmaniasis, the case presented here is the first reported case of VL in a lupus patient in Turkey.…”

Rapid Clinical Management of Leishmaniasis in Emergency Department: A Case Report with Clinical Review of Recent Literature

“…The onset of visceral Leishmaniasis can be acute and hard to make; anyway, no delay is allowed for treatment to prevent a potentially fatal evolution [ 18 ] ( Table 2 ).…”

Visceral Leishmaniasis Versus Systemic Lupus Erythematosus Flare—Old Axioms Sometimes Stay True Other Times Not

“…11 In Europe, L-AMB is recommended as first-line treatment, and as described in the literature, the patient became afebrile and asymptomatic within the first week. 15 A prolonged regime was provided as an option due to the patient's long-term immunosuppression and overall poor clinical condition.…”