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

CER3572
2009 Vol.27, N°3
PI 0503, PF 0506
Case Reports

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PMID: 19604446 [PubMed]

Abstract

OBJECTIVES:
Visceral leishmaniasis (VL) is an extremely rare example of opportunistic infection in patients treated with TNF-α 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.
CONCLUSIONS:
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.