Spontaneous remission of fully symptomatic visceral leishmaniasis.
BACKGROUND
Visceral leishmaniasis (VL), i.e., infection with Leishmania sp. associated with high fever, weight loss, massive splenomegaly and markedly altered laboratory parameters, is generally fatal if untreated. The possibility of transient spontaneous remission of fully symptomatic visceral leishmaniasis (VL) has been mentioned but, to our knowledge) has never been documented.


METHODS
We report the first documented history of a patient with overt, confirmed VL experiencing a complete remission in the absence of any anti-leishmanial therapy. The diagnosis of VL at the time of the self-resolving episode was strongly suspected based on clinical presentation and presence of antileishmanial antibody, then unequivocally confirmed years later by the presence of an amastigote on a stored smear and the positive quantitative PCR with Leishmania-specific primers from the material scraped from this same slide


CONCLUSIONS
This report demonstrates that complete spontaneous remission may occur in patients with overt, fully symptomatic VL. VL should therefore be considered in cases of self-resolving or relapsing episodes of fever of unknown origin. Confirmation should be based on both serological tests and specific PCR on a blood sample.
AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie, F-75013, Paris, France. oussama.mouri@psl.aphp.fr.
Oussama
O
Mouri
AP-HP, Hôpital Cochin, Service de Rééducation et Réadaptation, F-75014, Paris, France. mathilde.benhamou@aphp.fr.
Mathilde
M
Benhamou
AP-HP, Hôpital Pitié-Salpêtrière, Service de Médecine Interne, F-75013, Paris, France. gaelle.leroux@aphp.fr.
Gaëlle
G
Leroux
AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie, F-75013, Paris, France. nathaliechartrel@gmail.com.
Nathalie
N
Chartrel
Hopital Sud Francilien, Service d'Hématologie, Corbeil-Essonnes, France. alain.devidas@ch-sud-francilien.fr.
Alain
A
Devidas
AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie, F-75013, Paris, France. marc.thellier@psl.aphp.fr.|UPMC Université Paris 06, Centre Immunologie et Maladies Infectieuses, F-75005, Paris, France. marc.thellier@psl.aphp.fr.
Marc
M
Thellier
AP-HP, Hôpital Pitié-Salpêtrière, Service de Médecine Interne, F-75013, Paris, France. zahir.amoura@aphp.fr.
Zahir
Z
Amoura
AP-HP, Hôpital Cochin, Service de Médecine Interne. Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, F-75014, Paris, France. nathalie.costedoat@aphp.fr.
Nathalie
N
Costedoat-Chalumeau
AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie, F-75013, Paris, France. pabuffet@gmail.com.|UPMC Université Paris 06, Centre Immunologie et Maladies Infectieuses, F-75005, Paris, France. pabuffet@gmail.com.
Pierre
P
Buffet
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000909:Antibodies, Helminth / Q000097:blood; D016470:Bacteremia / Q000517:prevention & control; D017931:DNA Primers / Q000378:metabolism; D016054:DNA, Protozoan / Q000032:analysis; D006801:Humans; D016867:Immunocompromised Host; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology; D008297:Male; D060888:Real-Time Polymerase Chain Reaction; D012075:Remission, Spontaneous
D000900:Anti-Bacterial Agents; D000909:Antibodies, Helminth; D017931:DNA Primers; D016054:DNA, Protozoan