title: Leishmania in HLH: a rare finding with significant treatment implications.
abstract: Hemophagocytic lymphohistiocytosis (HLH) associated with visceral leishmaniasis (VL) is a very rare phenomenon. We report the first known North American case in a 21 month old boy. He was initially diagnosed with Epstein Barr virus (EBV) triggered HLH and treated with the international treatment protocol, HLH-2004. Stem cell transplant was planned due to repeated reactivations of disease, but his pretransplant bone marrow revealed an unexpected protozoan-Leishmania donovani. Treatment with liposomal amphotericin B led to resolution of all manifestations of HLH. We discuss how the clinical and laboratory features of both entities can closely mimic each other and are extremely difficult to differentiate. This case also raises the question of whether to screen all children with suspected HLH for Leishmania in a non endemic area.
authors.affiliation: Departments of Pediatric Hematology Oncology, Alberta Children's Hospital, University of Calgary, AB, Canada. gurpreet.singh@albertahealthservices.ca
authors.forename: Gurpreet
authors.initials: G
authors.lastname: Singh
authors.forename: Meer-Taher
authors.initials: MT
authors.lastname: Shabani-Rad
authors.forename: Otto G
authors.initials: OG
authors.lastname: Vanderkooi
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Vayalumkal
authors.forename: Susan M
authors.initials: SM
authors.lastname: Kuhn
authors.forename: Gregory M T
authors.initials: GM
authors.lastname: Guilcher
authors.forename: MacGregor
authors.initials: M
authors.lastname: Steele
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007893:Leishmania donovani / Q000472:pathogenicity; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000188:drug therapy* / Q000469:parasitology; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D016896:Treatment Outcome
chemical_list: D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B