title: Seronegative visceral leishmaniasis with relapsing and fatal course following rituximab treatment.
abstract: Both the presentation and clinical course of visceral leishmaniasis (VL) may be atypical in immunosuppressed subjects, often resulting in delayed diagnosis and treatment. We describe a case of VL characterized by negative serologic testing, a relapsing course, and a fatal outcome 2 years after the patient had been successfully treated for non-Hodgkin's lymphoma with rituximab. Diagnosis of VL may be further delayed or even missed in patients treated with drugs that interfere with specific antibody production unless specific diagnostic methods, such as bone marrow examination and parasite DNA amplification/detection, are routinely employed.
authors.affiliation: Infectious and Tropical Diseases Unit, Cardinal Massaja Hospital, Corso Dante 202, 14100 Asti, Italy. casabianca@asl.at.it
authors.forename: A
authors.initials: A
authors.lastname: Casabianca
authors.forename: M
authors.initials: M
authors.lastname: Marchetti
authors.forename: F
authors.initials: F
authors.lastname: Zallio
authors.forename: E
authors.initials: E
authors.lastname: Feyles
authors.forename: E
authors.initials: E
authors.lastname: Concialdi
authors.forename: E
authors.initials: E
authors.lastname: Ferroglio
authors.forename: A
authors.initials: A
authors.lastname: Biglino
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001853:Bone Marrow / Q000469:parasitology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007558:Italy; D018314:Leishmania infantum / Q000187:drug effects* / Q000302:isolation & purification; D007898:Leishmaniasis, Visceral / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control*; D007963:Leukocytes, Mononuclear / Q000469:parasitology*; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D012008:Recurrence; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D000069283:Rituximab; D000666:Amphotericin B