Distinguishing Visceral Leishmaniasis from Intolerance to Pegylated Interferon-α in a Thalassemic Splenectomized Patient Treated for Chronic Hepatitis C

Abstract

A 37-year-old splenectomized man affected by beta-thalassemia and chronic hepatitis, recently treated with pegylated interferon-alpha (Peg-IFN), was admitted because of elevated fever lasting 3 months and unresponsiveness to broad-spectrum antibiotics. Laboratory studies showed white blood cell and platelet counts within the normal range but lower than observed before Peg-IFN treatment and an elevated erythrocyte sedimentation rate. The blood transfusion rate was reported to be increased compared with the period preceding Peg-IFN treatment. A diagnosis of visceral leishmaniasis (VL) was made after Leishmania amastigotes were identified from Giemsa-stained smears of bone marrow aspirates. Cure occurred after liposomal amphotericin B was administered. Symptoms of VL may be difficult to distinguish from the manifestations of Peg-IFN intolerance. We suggest that VL must be suspected in any immunodepressed patient with an unexplained fever and a history of exposure in an endemic area.

Pediatric Visceral Leishmaniasis Caused by Leishmania infantum in Northern Cyprus

“…In such patients, symptoms may be nonspecific, with overlap between those of the underlying disease and VL, with fever absent and pancytopenia and weight loss the only signs reported 5,6…”

Hepatitis C virus distribution and clearance following interferon‐monotherapy among thalassaemia major and intermedia patients

“…There were no cases of thrombocytopenia. A case of Leishmaniosis required the interruption of PEG‐IFN therapy in one TM patient (Pagliano et al , 2008).…”