Fatal visceral leishmaniasis, with massive bone-marrow infection, in an immunosuppressed but HIV-negative Spanish patient, after the initiation of treatment with meglumine antimoniate

Abstract

Although visceral leishmaniasis is often fatal in the developing world, Leishmania-attributable deaths in Europe are relatively rare and nowadays almost always linked to HIV infection. In Spain, however, a HIV-negative man with a history of chronic obstructive pulmonary disease and prednisone treatment was recently hospitalized because of hypotension and asthenia. Although the patient was afebrile, a bone-marrow aspirate, collected after thrombo- and leuco-cytopenia had been observed, was found to contain huge numbers of amastigotes. A course of antileishmanial treatment with meglumine antimoniate was initiated but the patient went into refractory shock and died within 6 h. The significance of this case, in terms of the routine investigation and treatment of immunosuppressed patients who may have leishmaniasis, is discussed.

Visceral Leishmaniasis with Massive Pulmonary Involvement: A Case Report

“…Bleeding, multiple organ failure, and bacterial infections are the main causes of death in patients with VL (15). In addition, treatment with antimony drugs can interfere with patient viability (16,17). In this study, treatment initially began with amphotericin B and then continued with glucantime, which is an antimony drug.…”

Leishmaniasis in rheumatology, haematology and oncology: epidemiological, immunological and clinical aspects and caveats: Figure 1

“…The latter can result, for example, from HIV infections, antitumour and immune-ablative chemotherapies or immunosuppressive treatments with glucocorticoids, azathioprine, methotrexate, cyclophosphamide, the calcineurin inhibitors ciclosporin and tacrolimus, the mTOR inhibitors rapamycin (sirolimus) and everolimus, or with biological agents directed against TNF (anti-TNF-antibodies, soluble TNF receptor) or T cell costimulatory molecules. Consequently, immunosuppressed patients with AIDS,11 93 organ transplantations,2 94 haematopoietic malignancies (eg, leukaemia, lymphomas, Hodgkin's disease), autoimmune diseases (eg, systemic lupus erythematosus, rheumatoid arthritis, sarcoidosis, polyarteritis nodosa, Wegener's granulomatosis, Behçet's disease, myasthenia gravis), chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis) or allergic disorders (eg, asthma, atopic dermatitis) have all been shown to develop severe CL, VL or systemic leishmaniasis, either after primary infection or as a result of reactivation of persistent parasites 95–107. CL, mucosal leishmaniasis or VL can also develop in HIV-infected patients as a manifestation of an immune reconstitution inflammatory syndrome following highly active antiretroviral therapy 108…”

Unusual microbes in asthma exacerbation:Alcaligenes xylosoxidansand Leishmania

“…As previously mentioned, corticosteroid-taking subjects have developed leishmaniasis, although pulmonary involvement was not described [6]. In patients treated with long-term corticosteroids, disseminated mucocutaneous leishmaniasis [12], fatal visceral leishmaniasis [13], cutaneous and visceral leishmaniasis in a patient with systemic sarcoidosis [14], isolated lingual leishmaniasis as well as combined cutaneous and visceral leishmaniasis [6], and laryngeal leishmaniasis [15] have been reported since the early 2000s. Corticosteroids are known to negatively interfere with antigen processing and elimination of intracellular pathogens.…”