title: Hemophagocytic Lymphohistiocytosis Associated with Visceral Leishmaniasis: Varied Presentation.
abstract: Visceral leishmaniasis (VL) is endemic in many parts of India. Rarely, it may be complicated by hemophagocytic lymphohistiocytosis (HLH) that has varied presentation and course. We describe two cases of VL complicated by HLH that were markedly different in clinical presentation, course and management. First case presented with Fever of unknown origin whereas second case had fever with severe bleeding manifestations. VL was diagnosed by bone marrow aspiration and serum rk39 immunodiagnostic test respectively in these cases. HLH was diagnosed by HLH 2004 diagnostic criteria. VL was treated by intravenous amphotericin B in both cases. HLH was managed by treating primary disease in the first case whereas steroid was given for management in the second case. High index of suspicion is crucial for early diagnosis of HLH to reduce morbidity and mortality.
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029 India.
authors.forename: Piyush
authors.initials: P
authors.lastname: Ranjan
authors.affiliation: Medical Intern, All India Institute of Medical Sciences, New Delhi, 110029 India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Medical Intern, All India Institute of Medical Sciences, New Delhi, 110029 India.
authors.forename: Shuvadeep
authors.initials: S
authors.lastname: Ganguly
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029 India.
authors.forename: M
authors.initials: M
authors.lastname: Sukumar
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029 India.
authors.forename: Sanchit
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Hematology, All India Institute of Medical Sciences, New Delhi, 110029 India.
authors.forename: Neha
authors.initials: N
authors.lastname: Singh
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029 India.
authors.forename: Naval K
authors.initials: NK
authors.lastname: Vikram
authors.affiliation: Department of Hematology, All India Institute of Medical Sciences, New Delhi, 110029 India.
authors.forename: Hara Prasad
authors.initials: HP
authors.lastname: Pati
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029 India.
authors.forename: Rita
authors.initials: R
authors.lastname: Sood
keywords: Fever of unknown origin; Hemophagocytic lymphohistiocytosis (HLH); Kala-azar; Visceral leishmaniasis