title: [Treatment of severe hemophagocytic syndrome associated with visceral leishmaniasis].
abstract: The association of hemophagocytic syndrome (HS) and visceral leishmaniasis is a frequent disorder during infancy in endemic areas such as Tunisia. The range of severity of HS secondary to visceral leishmaniasis includes both pure biological forms that resolve with antimicrobial therapy and life-threatening emergencies that require specific treatment. We describe 2 cases of severe HS secondary to visceral leishmaniasis. The diagnosis of HS was based on the HLH-2004 diagnostic criteria. Therapy involved pentavalent antimonial (Glucantime) in both cases. The combination of corticosteroids with immunoglobulins, used in the 1st case, but introduced late, led to an unfavorable course and death. In the 2nd case, the specific treatment of HS was based on immunochemotherapy including etoposide and corticosteroids. Progression was favorable with a follow-up of 24 months. Etoposide containing therapeutic regimens can be proposed in severe forms of HS associated with visceral leishmaniasis.
authors.affiliation: Service de pédiatrie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie. jbouguila@yahoo.fr
authors.forename: J
authors.initials: J
authors.lastname: Bouguila
authors.forename: I
authors.initials: I
authors.lastname: Chabchoub
authors.forename: Y
authors.initials: Y
authors.lastname: Moncef
authors.forename: A
authors.initials: A
authors.lastname: Mlika
authors.forename: F
authors.initials: F
authors.lastname: Saghrouni
authors.forename: L
authors.initials: L
authors.lastname: Boughamoura
authors.forename: A S
authors.initials: AS
authors.lastname: Essoussi
mesh_terms: D000818:Animals; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005047:Etoposide / Q000627:therapeutic use; D017809:Fatal Outcome; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D007223:Infant; D007891:Leishmania / Q000302:isolation & purification; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology; D008536:Meglumine / Q000627:therapeutic use*; D000077485:Meglumine Antimoniate; D009942:Organometallic Compounds / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D000981:Antiprotozoal Agents; D005938:Glucocorticoids; D007136:Immunoglobulins; D009942:Organometallic Compounds; D008536:Meglumine; D005047:Etoposide; D000077485:Meglumine Antimoniate