title: Hemophagocytic Syndrome in Children With Visceral Leishmaniasis.
abstract: BACKGROUND
  Hemophagocytic lymphohistiocytosis (HLH) is a serious complication of visceral leishmaniasis (VL). The aim of this study is to describe demographical, clinical and laboratory features of HLH in children with VL.
  
  
  METHODS
  This is a retrospective cohort of children with HLH and VL admitted to a tertiary hospital in Northeast, Brazil, from January 2012 to April 2014. Clinical and laboratory data at admission and during hospital stay were reviewed. Acute kidney injury (AKI) was defined according to the pediatric Risk, Injury, Failure, Loss, End-stage kidney disease criteria.
  
  
  RESULTS
  A total 127 VL children were admitted, and 35 children had diagnosis of HLH. Mean age was 4.2 ± 4.3 years, with 62.9% males. Mean hospital stay was 29 ± 12 days. Main signs and symptoms were fever (100%), splenomegaly (94.2%) and hepatomegaly (60%). Laboratory findings showed pancytopenia, albumin 3.03 ± 0.77 g/dL, fibrinogen 236.1 ± 117.2 mg/dL, total calcium 8.2 ± 1.2 mEq/L, lactate dehydrogenase 1804 ± 1019 mg/dL, alkaline phosphatase 1275.4 ± 2160.5 IU/L, total bilirubin 1.9 ± 2.4 mg/dL, direct bilirubin 0.67 ± 1.02 mg/dL, indirect bilirubin 1.2 ± 2.2 mg/dL, aspartate aminotransferase 140.0 ± 145.3 IU/L, alanine aminotransferase 71.4 ± 81.1 IU/L, ferritin 4296.5 ± 8028.8 ng/dL and triglycerides 333 ± 141 mg/dL. AKI was observed in 16 children (45.7%), predominantly mild forms (93.75% "risk"). AKI group presented lower levels of platelets (69,131 ± 40,247 vs. 138,678 ± 127,494/mm, P = 0.035) than non-AKI. No patient required dialysis and there was no death.
  
  
  CONCLUSIONS
  HLH was not a rare complication of VL. Main symptoms were compatible with both VL and HLH. Main laboratory findings reflected HLH pathophysiology. Mild forms of AKI were a common complication of HLH. Despite the disease severity and complications, mortality was low.
authors.affiliation: From the *Department of Internal Medicine, School of Medicine, Post-Graduation Program in Medical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil; †Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil; ‡Division of Pediatric Nephrology, Albert Sabin Pediatric Hospital, Fortaleza, Ceará, Brazil; and §School of Medicine, Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil.
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Daher
authors.forename: Laio L L
authors.initials: LL
authors.lastname: Lima
authors.forename: Ana Patrícia F
authors.initials: AP
authors.lastname: Vieira
authors.forename: Lucas S
authors.initials: LS
authors.lastname: Nascimento
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Soares
authors.forename: Krasnalhia Lívia S
authors.initials: KL
authors.lastname: Abreu
authors.forename: Kathia L C R
authors.initials: KL
authors.lastname: Zuntini
authors.forename: Geraldo B
authors.initials: GB
authors.lastname: Silva Junior
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology*; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000453:epidemiology*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D012189:Retrospective Studies