Distinguishing visceral leishmaniasis from intolerance to pegylated interferon-alpha in a thalassemic splenectomized patient treated for chronic hepatitis C.
A 37-year-old splenectomized man affected by beta-thalassemia and chronic hepatitis, recently treated with pegylated interferon-alpha (Peg-IFN), was admitted because of elevated fever lasting 3 months and unresponsiveness to broad-spectrum antibiotics. Laboratory studies showed white blood cell and platelet counts within the normal range but lower than observed before Peg-IFN treatment and an elevated erythrocyte sedimentation rate. The blood transfusion rate was reported to be increased compared with the period preceding Peg-IFN treatment. A diagnosis of visceral leishmaniasis (VL) was made after Leishmania amastigotes were identified from Giemsa-stained smears of bone marrow aspirates. Cure occurred after liposomal amphotericin B was administered. Symptoms of VL may be difficult to distinguish from the manifestations of Peg-IFN intolerance. We suggest that VL must be suspected in any immunodepressed patient with an unexplained fever and a history of exposure in an endemic area.
Pagliano
Pasquale
P
D. Cotugno Hospital, Department of Emergency, 1st Division of Infectious Diseases, Naples, Italy. ppagliano@libero.it
Costantini
Silvia
S
Gradoni
Luigi
L
Faella
Francesco S
FS
Spasiano
Anna
A
Mascarella
Giuseppe
G
Prossomariti
Luciano
L
Fusco
Ugo
U
Ricchi
Paolo
P
D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D000818:Animals; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use*; D007891:Leishmania / Q000187:drug effects; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use*; D011994:Recombinant Proteins; D013156:Splenectomy; D017086:beta-Thalassemia / Q000150:complications* / Q000276:immunology
D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; C068538:liposomal amphotericin B; D011092:Polyethylene Glycols; D000666:Amphotericin B; C100416:peginterferon alfa-2a