Visceral Leishmaniasis Misdiagnosed as Malignant Lymphoma.

Kawakami, Akio; Fukunaga, T.; Usui, Michio; Asaoka, Hiroshi; Noda, Makoto; Nakajima, T.; Hashimoto, Yuji; Tanaka, Akira; Kishi, Yukio; Numano, Fujío

doi:10.2169/internalmedicine.35.502

Cited by 22 publications

(13 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These include chronic infections with bacterial or protozoan pathogens (eg, tuberculosis, brucellosis, toxoplasmosis),129 malignancies (eg, lymphoma, leukaemia, myelodysplastic syndrome),130 131 autoimmune diseases (eg, systemic lupus erythematosus; Wegener's granulomatosis; autoimmune hepatitis)132–136 as well as haemophagocytic lymphohistiocytosis (HLH) 125 137…”

Section: Differential Diagnoses and Diagnostic Pitfallsmentioning

confidence: 99%

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

Bogdan

2012

Ann Rheum Dis

View full text Add to dashboard Cite

Leishmaniasis is an intracellular protozoan infection that can lead to cutaneous, mucocutaneous, visceral or systemic manifestations depending on the parasite species and virulence and on the host immune response. It is endemic in countries of Europe (Mediterranean basin), Asia, Africa, Central and South America, but autochthonous cases begin to emerge outside classical disease areas. CD4+ T helper cells, interferon γ, dendritic cells and macrophages are the key components of antileishmanial defence. Leishmaniasis is an important differential diagnosis in patients with chronic lesions of the skin or mucous membranes or with fever, hepatosplenomegaly, lymphadenopathy, pancytopenia, histocytosis, haemophagocytic syndrome or glomerulonephritis. Organ transplant recipients and patients with autoimmune syndromes are at particular risk of developing visceral leishmaniasis following immunosuppressive therapy (eg, with steroids, methotrexate, ciclosporin or tumour necrosis factor-neutralising biological agents). Diagnosis and adequate treatment of leishmaniasis requires the combined use of culture, microscopic and nucleic acid amplication methods and species identification by sequencing and other molecular techniques. Standard regimens for the treatment of visceral leishmaniasis are intravenous liposomal amphotericin B (3 mg/kg body weight for 10 days) or oral miltefosine (150 mg/day for 28 days).

show abstract

Section: Differential Diagnoses and Diagnostic Pitfallsmentioning

confidence: 99%

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

Bogdan

2012

Ann Rheum Dis

View full text Add to dashboard Cite

show abstract

“…Tedavinin üçüncü gününde ateş yüksekliği gerileyen olgunun tedavisine 20 gün boyunca sodium stibogluconate intravenöz 500 mg/gün ile devam edilmiştir. Tedavi bitiminde kontrol kemikiliği biyopsisinde amastigot görülmeyen olguda klinik ve laboratuar olarak yanıt alınmıştır (6). Literatürdeki benzer yayınlara baktığımızda VL gibi kutanöz ve mukokutanöz Leishmaniasis'in de malign hastalıkları taklit edebildiği dikkati çekmektedir (7)(8)(9).…”

Section: Discussionunclassified

Co-occurence of Visceral Leishmaniasis and Lymphoma

Erdem¹,

Taşbakan²,

Pullukçu³

et al. 2014

TurkiyeParazitolDerg

View full text Add to dashboard Cite

ÖZETMalinite ve enfeksiyon klinik bulgu olarak birbirini taklit edebilen ve bu nedenle sıklıkla ayırıcı tanıda düşünülmesi gereken iki durumdur. Bu iki klinik durumun birlikteliği ise, immunsüpresif hastalar dışında oldukça nadirdir. Bu yazıda nedeni bilinmeyen ateş etiyolojisi araştırılırken önce Leishmaniasis tanısı alıp tedavi edilen ancak kontrol kemik iliği biyopsisinde diffuz B hücreli lenfoma olduğu saptanan bir hasta sunulmuştur. Ateş yüksekliği, kilo kaybı, karın ağrısı ve halsizlik yakınmaları ile başvuran ve malinite araştırılan hastanın, Bilgisayarlı Tomografi'sinde (BT) splenomegali ve biyokimyasal analizlerinde anemi ve hipergamaglobulinemi saptanmıştır. Leishmaniasis ön tanısı ile yapılan kemikiliği preparatında amastigotlar, NNN besiyerinde promastigot şekilleri görülmüştür. Liposomal Amfoterisin B tedavisi sonrasında uygulanan kontrol kemikiliği aspirasyonunda amastigot görülmeyen hastanın, patolojik bakısında diffüz büyük B hücreli lenfoma infiltrasyonu saptanmıştır. (Turkiye Parazitol Derg 2013; 37: 282-4 ABSTRACTClinicians have usually considered malignancies during follow up of patients who have infectious diseases as a pre-diagnosis. However, malignancy and an infectious disease are seen together more rarely, with the exception of immunosuppressed patients. This presentation is a case report followed up for fever of unknown origin. The patient was admitted to the hospital with the symptoms of fever, weight loss, abdominal pain and weakness. Anemia and hypergamaglobulinemia by biochemical analyses and splenomegaly by total body computed tomography were detected. Amastigotes were seen in bone marrow aspiration smears and promastigotes were isolated in NNN medium. At the end of the Liposomal Amphotericin B treatment, control bone marrow aspiration was applied. Leishmania amastigotes were not seen, while patient was diagnosed as diffuse B cell lymphoma pathologically. (Turkiye Parazitol Derg 2013; 37: 282-4)

show abstract

“…Errors are most likely to occur in a non-endemic area, when the clinical history becomes important. For example, a patient returning to Japan from India and the USA was misdiagnosed as having lymphoma, no leishmania having been detected in the first two of three bone marrow aspirates, which instead showed ‘a remarkable infiltration by monocytes and plasma cells’ 36. Similarly, three French children have been reported in whom a misdiagnosis of leishmaniasis as infection-related or familial haemophagocytic syndrome led to treatment with corticosteroids and etoposide, in one patient for as long as 5 months 37.…”

Section: The Aspirate Is Misinterpretedmentioning

confidence: 99%

Pitfalls in obtaining and interpreting bone marrow aspirates: to err is human

Bain

Bailey

2011

J Clin Pathol

View full text Add to dashboard Cite

Pitfalls relating to bone marrow aspirates and their interpretation start even before the aspirate is obtained. There can be failure to perform an aspiration that is clinically indicated or, conversely, an aspiration may be done that is not actually necessary. Once an aspirate is obtained it may be unhelpful because it is a blood tap or very dilute, or because of the sampling error that is intrinsic to the procedure. Even if an adequate aspirate is obtained, it may be misinterpreted. Megaloblastic marrows and children's marrows with increased haematogones or marked reactive changes are particularly prone to misinterpretation. A constant awareness of potential pitfalls and an assessment of the aspirate in the appropriate clinical context will help to reduce errors.

show abstract

Visceral Leishmaniasis Misdiagnosed as Malignant Lymphoma.

Cited by 22 publications

References 2 publications

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

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

Co-occurence of Visceral Leishmaniasis and Lymphoma

Pitfalls in obtaining and interpreting bone marrow aspirates: to err is human

Contact Info

Product

Resources

About