NEW MICROBIOLOGICA, 35, 93-95, 2012
Acute liver failure: a rare clinical presentation of visceral leishmaniasis Caterina Sagnelli1, Francesca Di Martino2, Nicola Coppola3, Antonello Crisci2, Evangelista Sagnelli3 1Department
of Clinical nd Experimental Medicine and Surgery “F. Magrassi e A. Lanzara, Second University of Naples, Italy; 2Department of Public Medicine, Law Medicine, Second University of Naples, Italy 3Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, Italy
SUMMARY We recently re-examined a case of Visceral Leishmaniasis, in a 36-year-old caucasian immune-competent men with an unusual clinical presentation. Together with symptoms and signs of a severe acute liver involvement, he presented weight loss, huge spleen enlargement, pancytopenia and increased γ-globulin serum level with a high polyclonal peak. He had no fever, but over-abundant night sweats were frequent. The patient was considered to have liver cirrhosis, and the diagnosis of visceral leishmaniosis was made with a year’s delay. From this case report we may learn that, despite an unusual clinical presentation, the diagnosis of visceral leishmaniasis should not be excluded when other characteristic signs and symptoms and laboratory abnormalities are present. KEY WORDS: Visceral leishmaniasis, Acute hepatitis Received June 23, 2011
INTRODUCTION Few cases of visceral leishmaniasis mimicking an acute hepatitis have been described in adults. This clinical presentation is infrequent also in infants and children, in these cases raising a difficult differential diagnosis with cholestatic syndromes in infancy (Pahwa R et al., 2004; Moragas A, et al., 1986; Giannitrapani L, et al., 2009; Singh NP, et al., 2006). The most frequent and prominent clinical symptoms and signs in visceral leishmaniasis are recurring fever, weight loss, weakness, profuse night sweats, enlargement of liver, spleen and lymphoid organs, anemia, neutropenia and thrombocytopenia. Patients with symptomatic visceral leishmaniasis may show all or some of these symptoms and signs, some factors such malnutrition or immune suppression, including HIV coinfec-
Corresponding author Evangelista Sagnelli Department of Public Medicine Section of Infectious Diseases Second University of Naples Via L. Armanni, 3 - 80135 Naples, Italy E-mail:
[email protected]
Accepted October 12, 2011
tion, increasing the likelihood of a more severe or prolonged clinical course. Visceral leishmaniasis is usually fatal if not treated both in adults and children. Some authors recently investigated the risk factors for death associated with visceral leishmaniasis in children and found a case-fatality rate of 10%, the independent predictors of risk of dying from visceral leishmaniasis being mucosal bleeding, jaundice, dyspnea, suspected or confirmed bacterial infections, neutrophil count
