Recurrence of visceral and muco-cutaneous leishmaniasis in a patient under immunosuppressive therapy.
- Darcis G Centre Hospitalier Universitaire (CHU) de Liège, Liège, Belgium. gdarcis@chu.ulg.ac.be.
- Van der Auwera G Institute of Tropical Medicine, Antwerp, Belgium.
- Giot JB Centre Hospitalier Universitaire (CHU) de Liège, Liège, Belgium.
- Hayette MP Centre Hospitalier Universitaire (CHU) de Liège, Liège, Belgium.
- Tassin F Centre Hospitalier Universitaire (CHU) de Liège, Liège, Belgium.
- Arrese Estrada J Centre Hospitalier Universitaire (CHU) de Liège, Liège, Belgium.
- Cnops L Institute of Tropical Medicine, Antwerp, Belgium.
- Moutschen M Centre Hospitalier Universitaire (CHU) de Liège, Liège, Belgium.
- de Leval L Service of clinical Pathology, Lausanne University Hospital, Lausanne, Switzerland.
- Leonard P Centre Hospitalier Universitaire (CHU) de Liège, Liège, Belgium.
- 2017-07-09
Published in:
- BMC infectious diseases. - 2017
Cutaneous leishmaniasis
Immunosuppression
Microbiology
Mucosal leishmaniasis
Parasitology
Visceral leishmaniasis
Amphotericin B
Antiprotozoal Agents
Biopsy
Female
Humans
Immunocompromised Host
Leishmania
Leishmaniasis, Cutaneous
Leishmaniasis, Visceral
Macrophages
Middle Aged
Paromomycin
Phosphorylcholine
Polymerase Chain Reaction
Recurrence
English
BACKGROUND
Leishmaniasis is a protozoan disease caused by parasites of the genus Leishmania, transmitted to humans by sandflies. The diagnosis of leishmaniasis is often challenging as it mimics many other infectious or malignant diseases. The disease can present in three ways: cutaneous, mucocutaneous, or visceral leishmaniasis, which rarely occur together or consecutively.
CASE PRESENTATION
The patient was a 52 years old immunosuppressed Belgian woman with a long history of severe rheumatoid arthritis. She underwent bone marrow biopsy to explore thrombocytopenia. Diagnosis of visceral leishmaniasis was made by identification of Leishman Donovan (LD) bodies in macrophages. Treatment with liposomal amphotericin B was successful. She later developed cutaneous leishmaniasis treated with amphotericin B lipid complex. She next presented with relapsing cutaneous lesions followed by rapidly progressing lymphadenopathies. Biopsy confirmed the diagnosis of leishmaniasis. Treatments by miltefosine, amphotericin B, N-methyl-glucamine antimoniate were subsequently initiated. She later presented a recurrent bone marrow involvement treated with intramuscular paromomycin and miltefosine. She died two years later from leukemia. At the time of death, she presented with a mucosal destruction of the nose. A Leishmania-specific PCR (Polymerase Chain Reaction) identified L. infantum as etiological agent.
CONCLUSIONS
Clinicians should be aware of the potential concomitant or sequential involvement of multiple anatomic localizations of Leishmania in immunosuppressed patients.
Leishmaniasis is a protozoan disease caused by parasites of the genus Leishmania, transmitted to humans by sandflies. The diagnosis of leishmaniasis is often challenging as it mimics many other infectious or malignant diseases. The disease can present in three ways: cutaneous, mucocutaneous, or visceral leishmaniasis, which rarely occur together or consecutively.
CASE PRESENTATION
The patient was a 52 years old immunosuppressed Belgian woman with a long history of severe rheumatoid arthritis. She underwent bone marrow biopsy to explore thrombocytopenia. Diagnosis of visceral leishmaniasis was made by identification of Leishman Donovan (LD) bodies in macrophages. Treatment with liposomal amphotericin B was successful. She later developed cutaneous leishmaniasis treated with amphotericin B lipid complex. She next presented with relapsing cutaneous lesions followed by rapidly progressing lymphadenopathies. Biopsy confirmed the diagnosis of leishmaniasis. Treatments by miltefosine, amphotericin B, N-methyl-glucamine antimoniate were subsequently initiated. She later presented a recurrent bone marrow involvement treated with intramuscular paromomycin and miltefosine. She died two years later from leukemia. At the time of death, she presented with a mucosal destruction of the nose. A Leishmania-specific PCR (Polymerase Chain Reaction) identified L. infantum as etiological agent.
CONCLUSIONS
Clinicians should be aware of the potential concomitant or sequential involvement of multiple anatomic localizations of Leishmania in immunosuppressed patients.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1186/s12879-017-2571-x
- PMID 28687071
- Persistent URL
- https://folia.unifr.ch/global/documents/181532
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