Visceral leishmaniasis in immunocompromised patient
Journal Title: Αρχεία Ελληνικής Ιατρικής - Year 2008, Vol 25, Issue 2
Abstract
A 62-year-old farmer diagnosed with IgGκ multiple myeloma, stage 2 according to ISS, in February 2004. He was symptomatic due to lytic bone disease in the lumbar spine and mild anemia (Hb 10.8 g/dl). He received 4 cycles of VAD chemotherapy followed by high dose melphalan (200 mg/m2) and autologous stem cell support (ASCT). The patient achieved complete remission post-ASCT. After ASCT he had been on prophylaxis with acyclovir and co-trimoxazole for six months. Eight months post-ASCT, the patient presented with generalized weakness, dizziness and fatigue of 15 days duration. Two days before admission the patient started to have fever up to 38.7 oC which was reduced by paracetamol. The physical examination revealed severe pallor and pedal edema. His temperature was 38.5 oC, the pulse rate was 110/min and the blood pressure was 140/90 mmHg. Respiratory and cardiovascular xaminations were normal. There was no hepatosplenomegaly. The hematological investigations showed: Hb 6.2 g/dL with normal platelet (178×109/L), white blood cell (7.5×109/L) and differential cell counts. Peripheral smear demonstrated microcytic red cells. The reticulocyte count was normal. Liver and renal function tests were also normal. LDH was elevated (560 U/L) but bilirubin was normal. Coombs direct test was negative. There was severe hypergammaglobulinemia but no monoclonal component was observed in serum electrophoresis and immunoelectrophoresis. Urinary and serum κ and λ free-light chain measurement was within normal range. Chest X-rays revealed no lung infection, while blood and urine cultures were negative for the development of bacteria. The absence of splenomegaly was confirmed with ultrasound of the abdomen. The administration of ceftazidime, amikacin, and teicoplanin initially and imipenem subsequently had no effect on fever. Bone marrow aspiration revealed a reactive marrow and a large number of bodies that are depicted. Serology confirmed the diagnosis. The patient was treated with the appropriate treatment. There were no treatment-related complications during the course, except for transient hypokalemia. The patient gradually improved symptomatically with treatment. His hemoglobin increased to 9.8 g/dL at the end of 4 weeks. Repeat bone marrow aspiration was negative for the infectious agent and in respective serology the antibody titer was decreased by 50% compared to initial value.
Authors and Affiliations
A. Sarantopoulos, S. Masouridi, C. Bomboris, Y. Dalamagas, M. Rodopoulou, J. Asimakopoulos, E. Variami, N. Viniou
Keywords
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