The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Letter to the Editor

Visceral Leishmaniasis Mimicking Lymphoproliferative Disease

Authors: Katerina Kaziani, MD, Chariclea Vadala, MD, Panagiota Stasinopoulou, MD, Dionysios Loverdos, MD, Michael Samarkos, MD, Athanasios Skoutelis MD

Abstract

To the Editor:


A 45-year-old shepherd was admitted for fever, malaise, and loss of weight for a duration of 20 days. The physical examination revealed no remarkable findings; there was no organomegaly or adenopathy. Pancytopenia, mildly elevated liver enzymes, and polyclonal hypergammaglobulinemia were noticed. Bone marrow aspiration revealed no specific pathology, while bone marrow biopsy showed a mixed type nodular lymphoid infiltrate, representing 5-8% of all marrow cells. Serological studies revealed findings consistent with relapsed brucellosis, as well as a borderline positive titer of antibodies against Leishmania donovani. Due to his epidemiological history, the patient was empirically treated for relapsed brucellosis. When fever and pancytopenia relapsed, a new bone marrow aspiration was performed, this time revealing numerous intracellular amastigotes of Leishmania species (Fig.). The patient was successfully treated with liposomal amphotericin B, followed by complete clinical and laboratory remission. Six months later, a bone marrow biopsy was repeated, and no lymphocytic infiltration was recognized in the new sample.

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