title: Pancytopenia during tyrosine kinase inhibitor treatment - coexistence of chronic myeloid leukemia and visceral leishmaniasis: a case report.
abstract: BACKGROUND
  Visceral leishmaniasis is a zoonosis characterized by chronic evolution of symptoms; it usually appears 2 to 4 months after the initial infection, with multiple cutaneous lesions and systemic involvement, which if left untreated results in death in 90 % of cases.
  
  
  METHODS
  We present a case of 29-year-old white male farmer, with chronic myeloid leukemia treated with imatinib who developed significant pancytopenia, leading to discontinuation of treatment. His neutrophil count fell to 0.5 × 10(9)/L, his platelets dropped to 85 × 10(9)/μL, and his hemoglobin was 6.4 g/dL. A bone marrow study was performed, showing complete remission of chronic myeloid leukemia and numerous Leishmania amastigotes within the macrophages. He used pentavalent antimonials replaced by amphotericin B due to acute cardiac toxicity. After 3 months, imatinib was restarted, and he again showed adequate control of the disease. The last polymerase chain reaction assessment showed a deep molecular response.
  
  
  CONCLUSIONS
  The hypothesis of an adverse event or secondary resistance to tyrosine kinase inhibitors, with subsequent progression to advanced disease, was initially raised, although a detailed evaluation has shown that it was an associated infectious disease.
authors.affiliation: Department of Haematology, Walter Cantidio University Hospital, 1210 Captain Francisco Pedro St, 60430-350, Rodolfo Teofilo, Fortaleza, Ceará, Brazil. acy@uol.com.br.
authors.forename: Acy
authors.initials: A
authors.lastname: Quixada
authors.affiliation: Research Laboratory in Hemoglobinopathies and Genetics of Hematologic Diseases, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Pedro Aurio Maia
authors.initials: PA
authors.lastname: Filho
authors.affiliation: Research Laboratory in Hemoglobinopathies and Genetics of Hematologic Diseases, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Tarcísio Paulo Almeida
authors.initials: TP
authors.lastname: Filho
authors.affiliation: Department of Surgery, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Fernando Barroso
authors.initials: FB
authors.lastname: Duarte
authors.affiliation: Research Laboratory in Hemoglobinopathies and Genetics of Hematologic Diseases, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Caroline Aquino
authors.initials: CA
authors.lastname: Moreira-Nunes
authors.affiliation: Research Laboratory in Hemoglobinopathies and Genetics of Hematologic Diseases, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Romélia Pinheiro Gonçalves
authors.initials: RP
authors.lastname: Lemes
mesh_terms: D000328:Adult; D006801:Humans; D000068877:Imatinib Mesylate / Q000009:adverse effects / Q000627:therapeutic use*; D007898:Leishmaniasis, Visceral / Q000150:complications*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D010198:Pancytopenia / Q000150:complications* / Q000175:diagnosis; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*
chemical_list: D047428:Protein Kinase Inhibitors; D000068877:Imatinib Mesylate
keywords: Chronic myeloid leukemia; Tyrosine kinase inhibitors; Visceral leishmaniasis