Blood Research Educational Material BLOOD RESEARCH Volume 49ㆍNumber 4ㆍDecember 2014 http://dx.doi.org/10.5045/br.2014.49.4.215
Visceral leishmaniasis in an Afghan woman with systemic lupus erythematosus Sadia Sultan, Syed Mohammad Irfan Hematology Department, Liaquat National Hospital, Pakistan Correspondence to Sadia Sultan, MBBS, FCPS, Hematology Department, Liaquat National Hospital, National Stadium Road, Karachi 74800, Pakistan, E-mail: [email protected]
A 35-year-old Afghan woman with systemic lupus erythematosus for 3 years had been on immunosuppressive and low-dose steroid therapy for 1 year. She presented with fever, abdominal pain, and excessive sweating for 2 months. Generalized lymphadenopathy, hepatomegaly, splenomegaly, and hyperpigmentation of the forehead, abdomen, and 9
hands were noted. Laboratory tests revealed hemoglobin level of 7.9 g/dL, white blood cell counts of 1.0×10 /L, 9 9 absolute neutrophil counts of 0.4×10 /L, and platelet counts of 56×10 /L. A peripheral blood smear revealed
polychromasia, spherocytes, and nucleated red blood cells. In the bone marrow, abundant intracellular (A) and extracellular amastigotes appearing as single cells (B) or in small clusters (C) were detected. Numerous macrophages loaded with amastigotes were seen (D and E) in a trephine biopsy. The patient was treated with stibogluconate and responded well to therapy. Peripheral counts were normalized after 2 weeks, visceromegaly was resolved after 3 weeks, and no amastigotes were found in the bone marrow at the end of treatment. Physicians should be aware of the possibility of an underlying parasitic infestation in immunocompromised patients, as cytopenia may not always be due to primary disease or a consequence of immunosuppressive therapy. 215 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Visceral leishmaniasis in an Afghan woman with systemic lupus erythematosus Sadia Sultan, Syed Mohammad Irfan Hematology Department, Liaquat National Hospital, Pakistan Correspondence to Sadia Sultan, MBBS, FCPS, Hematology Department, Liaquat National Hospital, National Stadium Road, Karachi 74800, Pakistan, E-mail: [email protected]
A 35-year-old Afghan woman with systemic lupus erythematosus for 3 years had been on immunosuppressive and low-dose steroid therapy for 1 year. She presented with fever, abdominal pain, and excessive sweating for 2 months. Generalized lymphadenopathy, hepatomegaly, splenomegaly, and hyperpigmentation of the forehead, abdomen, and 9
hands were noted. Laboratory tests revealed hemoglobin level of 7.9 g/dL, white blood cell counts of 1.0×10 /L, 9 9 absolute neutrophil counts of 0.4×10 /L, and platelet counts of 56×10 /L. A peripheral blood smear revealed
polychromasia, spherocytes, and nucleated red blood cells. In the bone marrow, abundant intracellular (A) and extracellular amastigotes appearing as single cells (B) or in small clusters (C) were detected. Numerous macrophages loaded with amastigotes were seen (D and E) in a trephine biopsy. The patient was treated with stibogluconate and responded well to therapy. Peripheral counts were normalized after 2 weeks, visceromegaly was resolved after 3 weeks, and no amastigotes were found in the bone marrow at the end of treatment. Physicians should be aware of the possibility of an underlying parasitic infestation in immunocompromised patients, as cytopenia may not always be due to primary disease or a consequence of immunosuppressive therapy. 215 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
