title: Visceral leishmaniasis with associated immune dysregulation leading to lymphoma.
abstract: OBJECTIVE
  We describe an atypical presentation of visceral leishmaniasis (VL) complicated by Epstein-Barr virus (EBV)-lymphoproliferative disorder and angioimmunoblastic T-cell lymphoma in a U.S. Government contractor recently deployed to Iraq and Afghanistan.
  
  
  METHODS
  We performed a search of PubMed (1966-2012) using the terms visceral, leishmaniasis, operation, iraqi, freedom, desert, storm, EBV, lymphoproliferative, angioimmunoblastic, and lymphoma. The purpose of the search was two-fold: to find reported cases of VL during U.S. military operations and to ascertain if lymphoproliferative disorder (specifically, because of EBV) was ever described as a sequelae of VL.
  
  
  RESULTS
  Case series of VL acquired in the Middle East between 1990 and 2012 showed that while fever, abdominal pain, and hepatosplenomegaly were common signs and symptoms of VL, diffuse lymphadenopathy (our patient's presentation) was rare. Moreover, VL in and of itself lends to profound immune dysregulation, leading to a myriad of complications to include EBV-lymphoproliferative diseases.
  
  
  CONCLUSIONS
  Diffuse lymphadenopathy because of VL is a very atypical presentation for infection acquired in the Middle East. Clinicians must be mindful of the extreme immune dysfunction that occurs as a result of this potentially fatal infection and the associated complications to include EBV-related lymphoproliferative disorders and lymphoma.
authors.affiliation: Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Miami Valley Hospital, Weber CHE Building, 2nd Floor, 128 East Apple Street, Dayton, OH 45409, USA.
authors.forename: Nwamaka M
authors.initials: NM
authors.lastname: Osakwe
authors.forename: Andrew
authors.initials: A
authors.lastname: Paulus
authors.forename: Paul F
authors.initials: PF
authors.lastname: Haggerty
authors.forename: Roger A
authors.initials: RA
authors.lastname: Wood
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Becker
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Weina
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Dolan
authors.forename: Vidhya
authors.initials: V
authors.lastname: Prakash
mesh_terms: D006801:Humans; D007111:Immunity, Cellular; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D016399:Lymphoma, T-Cell / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D013601:T-Lymphocytes / Q000276:immunology*; D014057:Tomography, X-Ray Computed