Immunological features of visceral leishmaniasis may mimic systemic lupus erythematosus.
OBJECTIVE
Visceral leishmaniasis (VL), caused by the intracellular parasite Leishmania, can present with fever, splenomegaly, pancytopenias, hypergammaglobulinemia, and autoantibody production. These features may mimic systemic lupus erythematosus (SLE). The objective was to study features of VL that shared with and differed from SLE.


METHODS
A small retrospective study of six patients with VL diagnosed in a University Hospital between 2001 and 2007.


RESULTS
All patients had cytopenias, firm splenomegaly, high acute phase reactants, and activation of the coagulation cascade. Hypergammaglobulinemia was detected in five patients. Direct Coombs test was positive in all patients, anti-nuclear antibodies were detected in five patients, anti-smooth muscle antibodies (ASMA) in four patients, and IgM rheumatoid factor (RF) in four patients. Anti-dsDNA antibodies were detected in one patient and IgM anti-cardiolipin antibodies were detected in one patient.


CONCLUSIONS
Autoantibodies are frequently detected in VL and may mimic SLE, but massive firm splenomegaly, very high acute phase reactants, and activation of coagulation system with high D-dimers point toward infection.
Sakkas
Lazaros I
LI
Department of Internal Medicine and Rheumatology, Thessaly University School of Medicine and University Hospital of Larisa, Larisa 41110, Greece. Isakkas@med.uth.gr
Boulbou
Maria
M
Kyriakou
Despina
D
Makri
Irene
I
Sinani
Chrysanthi
C
Germenis
Anastasios
A
Stathakis
Nikolaos
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000974:Antibodies, Antinuclear / Q000032:analysis; D001323:Autoantibodies / Q000032:analysis / Q000276:immunology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000276:immunology*; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D018716:Molecular Mimicry; D012189:Retrospective Studies
D000974:Antibodies, Antinuclear; D001323:Autoantibodies