• M Schmutz, T Schaller, B Kubuschok, C Fleischmann, K Hirschbühl, S Dintner, T Häckel, B Märkl, M Trepel, and R Claus.
• 2. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland. maximilian.schmutz@ak-augsburg.de.
• Internist (Berl). 2019 Dec 1; 60 (12): 1305-1310.

Medical History And Initial PresentationA 35-year-old patient with a previous history of persistent episodic fever, sore throat, myalgia, and cephalgia presented for evaluation of pancytopenia. He had no recent travel history, except for a stay in Italy 1 year prior to admission and in Spain several years in the past.Diagnostic WorkupLaboratory evaluation confirmed pancytopenia, agranulocytosis, and elevated infection parameters without indicative serological results en par with lymphadenitis colli. Computed tomography scanning revealed cervical lymphadenopathy, hepatosplenomegaly, and colitis with occult perforation of the sigmoid colon. Bone marrow biopsy showed an infiltration of polyclonal plasma cells. Lymph node biopsy was compatible with necrotizing lymphadenitis.DiagnosisPolymerase chain reaction analysis of a lymph node specimen confirmed the presence of Leishmania species, thereby enabling the diagnosis of visceral Leishmania.Therapy CourseTreatment with liposomal amphotericin B was initiated. Both fever and lymphadenopathy quickly resolved.ConclusionVL is a clinically pleiotropic, severe disease with fatal outcome if left untreated. It often presents with distinct similarities to hematologic malignancies. Exacerbation can occasionally occur as fulminant macrophage activation syndrome. Disease incidence is globally increasing and has not peaked as yet. A complex interplay between pathogen and the immune system is the key pathophysiological mechanism.

38 keywords...

hide…