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Clin Exp Rheumatol. 2009 May-Jun;27(3):503-6.

Visceral leishmaniasis and anti-TNF-alpha therapy: case report and review of the literature.

Author information

1
Section of Rheumatology, Department of Clinical and Experimental Medicine, University of Ferrara, 44100, Ferrara, Italy. dlnfnc@unife.it

Abstract

OBJECTIVES:

Visceral leishmaniasis (VL) is an extremely rare example of opportunistic infection in patients treated with TNF-alpha antagonists and only a few cases have been described. In this paper risk factors, clinical features, diagnostic work-up and outcome of patients developing VL under biologic therapy are described.

METHODS:

Case report and review of the published cases of VL in patients under biologic treatment.

RESULTS:

We retrieved six patients, including ours, all of whom presented anarchic fever and pancytopenia. In 5 cases, splenomegaly was detected. The same number of patients came from endemic areas for VL. In the majority of the cases a bone marrow examination was not diagnostic, requiring the performance of a second one and/or the execution of other diagnostic tests. One fatal outcome was observed.

CONCLUSION:

Even if VL represents a sporadic complication of biologic treatments, its presence should always be suspected in patients developing a triad of signs and symptoms constituted by fluctuant fever, pancytopenia and splenomegaly, especially if coming from endemic areas. In these cases an extensive diagnostic work-up must be warranted. Atypical and confusing features may resemble autoimmune diseases at presentation and during the course of the illness.

PMID:
19604446
[Indexed for MEDLINE]

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