Fatal visceral leishmaniasis, with massive bone-marrow infection, in an immunosuppressed but HIV-negative Spanish patient, after the initiation of treatment with meglumine antimoniate.
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.
Garcia-Cordoba
F
F
Intensive Care Unit, Hospital Morales Meseguer, Marques de los Velez s/n, E-30008, Murcia, Spain. fortunog@aehh.org
Ortuño
F J
FJ
Segovia
M
M
Gonzalez Diaz
G
G
D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001853:Bone Marrow / Q000469:parasitology; D001855:Bone Marrow Diseases / Q000188:drug therapy / Q000276:immunology* / Q000469:parasitology; D017809:Fatal Outcome; D005938:Glucocorticoids / Q000009:adverse effects; D018023:HIV Seronegativity / Q000276:immunology*; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000188:drug therapy; D016867:Immunocompromised Host; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D008297:Male; D008536:Meglumine / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use; D011241:Prednisone / Q000009:adverse effects; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy
D000981:Antiprotozoal Agents; D005938:Glucocorticoids; D009942:Organometallic Compounds; D008536:Meglumine; D000077485:Meglumine Antimoniate; D011241:Prednisone