Article

Visceral Leishmaniasis Mimicking Autoimmune Hepatitis, Primary Biliary Cirrhosis, and Systemic Lupus Erythematosus Overlap

Department of Clinical Microbiology and Infectious Diseases, Gazi University Hospital Besevler, 06500 Ankara, Turkey.
The Korean Journal of Parasitology (Impact Factor: 0.97). 06/2012; 50(2):133-6. DOI: 10.3347/kjp.2012.50.2.133
Source: PubMed

ABSTRACT Visceral leishmaniasis (VL) is a life-threatening infection caused by Leishmania species. In addition to typical clinical findings as fever, hepatosplenomegaly, and cachexia, VL is associated with autoimmune phenomena. To date, VL mimicking or exacerbating various autoimmune diseases have been described, including systemic lupus erythematosus (SLE), rheumatoid arthritis, and autoimmune hepatitis (AIH). Herein, we presented a patient with VL who had overlapping clinical features with SLE, AIH, as well as antimitochondrial antibody (AMA-M2) positive primary biliary cirrhosis.

0 Followers
 · 
280 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: After HIV epidemic several countries reported co-infections of Leishmania with HIV. The co-infection of these two pathogens results into rapid disease progression, more severe disease and poor response to treatment. A systematic review of literature from India is presented here. On reviewing the literature since first case of visceral leishmaniasis (VL) and HIV was published from India in 1999, a number of cases of HIV-leishmania co-infections have been reported, but the proportion has been low (0.029-0.4%) as reported to other countries where both these diseases are co-endemic. So far, more than 89 cases of VL-HIV and 10 cases of cutaneous leishmaniasis (CL) with HIV have been published since 1999. Of these 10 cases, 5 had simple CL and 5 cases manifested with diffuse cutaneous leishmaniasis (DCL). In addition, one case of post-kala-azar mucocutaneous leishmaniasis (PKML) in a full blown AIDS patient has also been reported. In two cases no clear description could be ascertained whether these were cases of DCL or post-kala-azar dermal leishmaniasis (PKDL). Though the first case of VL-HIV co-infection was reported from sub-Himalayan state of Uttarakhand, most cases are reported from VL endemic state of Bihar. HIV-Leishmania is not alarmingly high in India. Most cases occurred during 1997-2007. After that the number of new cases has gone down. Most probably due to low HIV prevalence in VL and CL endemic regions and free supply of highly active anti-retroviral therapy (HAART) for HIV infected patients.
    International Journal of Infectious Diseases 10/2014; DOI:10.1016/j.ijid.2014.07.011 · 2.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Systemic lupus erythematosus (SLE) is an autoimmune disease that may present manifestations that resemble other diseases. Visceral leishmaniasis (VL) is a parasitic infection whose hallmarks may mimic SLE symptoms. Here, we report a case series and evaluate the published, scientific evidence of the relationship between SLE and VL infection. To assess original studies reporting cases of VL-infected patients presenting manifestations that are capable of leading to inappropriate suspicions of SLE or mimicking an SLE flare, we performed an extensive search in several scientific databases (MEDLINE, LILACS, SciELO, and Scopus). Two authors independently screened all citations and abstracts identified by the search strategy to identify eligible studies. Secondary references were additionally obtained from the selected articles. The literature search identified 53 eligible studies, but only 17 articles met our criteria. Among these, 10 lupus patients with VL mimicking an SLE flare and 18 cases of VL leading to unappropriated suspicions of SLE were described. The most common manifestations in patients infected with VL were intermittent fever, pancytopenia, visceromegaly, and increased serum level of acute phase reactants. The most frequent autoantibodies were antinuclear antibodies, rheumatoid factor, and direct Coombs' test. In endemic areas for VL, the diagnosis of SLE or its exacerbation may be a clinical dilemma. Hepatosplenomegaly or isolated splenomegaly was identified in the majority of the reported cases where VL occurred, leading to unappropriated suspicions of SLE or mimicking an SLE flare. Furthermore, the lack of response to steroids, the normal levels of complement proteins C3 and C4, and the increased level of transaminases suggest a possible infectious origin. Copyright © 2015 Elsevier Inc. All rights reserved.
    Seminars in Arthritis and Rheumatism 12/2014; DOI:10.1016/j.semarthrit.2014.12.004 · 3.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Platelet satellitism is considered an uncommon phenomenon with an estimated frequency at 0.008%. About 100 cases have been published. If not recognized, this artifact can lead to an erroneous diagnosis of thrombocytopenia. We report the case of a patient, with cutaneous leishmaniasis, who developed an isolated thrombocytopenia. The blood smear prepared from peripheral blood sample collected with ethylenediaminetetraacetic acid showed platelets rosetting around polymorphonuclear. This phenomenon disappeared after treatment with Glucantime® for fifteen days and improvement of the lesions. We discuss also possible mechanisms to better understand this phenomenon.
    Annales de biologie clinique 12/2014; 72(6):743-746. DOI:10.1684/abc.2014.1017 · 0.42 Impact Factor

Full-text (2 Sources)

Download
2 Downloads
Available from
Apr 14, 2015