title: [Visceral leishmaniasis: not only a tropical disease].
abstract: We report 2 cases of visceral leishmaniasis in Dutch patients after a stay in Greece and the former Yugoslavia, respectively. Patient A, a 69-year-old woman, was referred to our department with abdominal pain. Additional examinations were suggestive of chronic liver disease. After a liver biopsy, which demonstrated hepatic granulomas, we admitted the patient due to a sudden onset of cyclic fever. Patient B, a 50-year-old woman, was admitted with cyclic fever and abdominal pain. We treated the patient with IV antibiotics and discontinued the methotrexate treatment for her rheumatoid arthritis. Both patients were diagnosed with visceral leishmaniasis and treated with liposomal amphotericin-B. Patient A, an immunocompetent patient, had stayed in Greece for prolonged periods. Patient B had lived in the former Yugoslavia until 1999, and her methotrexate use had likely activated an asymptomatic Leishmania infection. Visceral leishmaniasis, a potentially lethal protozoan disease, should be considered in patients who have travelled in Southern Europe.
authors.affiliation: UMC St Radboud, Afd. Maag-, Darm- en Leverziekten, Nijmegen, the Netherlands. franscuperus@gmail.com
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Cuperus
authors.forename: Peter R
authors.initials: PR
authors.lastname: Oosterwijk
authors.forename: Anja
authors.initials: A
authors.lastname: Vos
authors.forename: Jasper A
authors.initials: JA
authors.lastname: Remijn
authors.forename: Aart
authors.initials: A
authors.lastname: van Dobbenburgh
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Bisseling
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000188:drug therapy; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D005260:Female; D006115:Greece / Q000208:ethnology; D006801:Humans; D018314:Leishmania infantum / Q000302:isolation & purification*; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009426:Netherlands; D014195:Travel; D016896:Treatment Outcome; D015022:Yugoslavia / Q000208:ethnology
chemical_list: D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B; D008727:Methotrexate