Visceral leishmaniasis: an unexpected diagnosis during the evaluation of pancytopenia in a kidney transplant recipient
Autor(a) principal: | |
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Data de Publicação: | 2013 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692013000200008 |
Resumo: | The aetiological study of cytopenia in solid organ transplant recipients could be challenging, given the need to exclude infectious disorders, drug toxicity or neoplastic disease. Visceral leishmaniasis is endemic in several regions of the world, but a rare complication after renal transplantation (less than 100 cases described in literature). We report the case of a male renal transplant recipient, 57 years of age, admitted to our Unit 17 months after transplantation with febrile illness and severe pancytopenia. He had a history of leucopenia and thrombocytopenia detected in follow-up exams two months earlier, with progressive worsening despite discontinuation of drugs with potential haematologic toxicity. On admission, his complaints were weakness, night sweats and weight loss. On examination, he was febrile, pale, and had a palpable spleen. Laboratory exams demonstrated: leukocytes 1.1 x109/L, platelets 68 x109/L, haemoglobin 10.3 g/dl, serum creatinine 1.48 mg/dl, C-reactive protein 9.72 mg/dl. Abdominal ultrasound confirmed splenomegaly. A bone marrow aspiration was performed and antibiotic therapy was instituted empirically, without improvement. Additional laboratory results were inconclusive: negative blood and urine cultures, no evidence of cytomegalovirus, parvovirus B19 or HIV infections, hepatitis B and C and masses/ adenopathies were excluded by computerized tomography. Despite the absence of an evident epidemiological context, the bone marrow examination showed amastigotes of Leishmania spp. He was started on liposomal amphotericin B (4 mg/kg/day; total of 10 administrations) with a sustained clinical and laboratory improvement after the second day of therapy. Visceral leishmaniasis is a potentially lethal infection if treatment is delayed or not instituted. Although rare among renal transplant recipients it should be included in the differential diagnosis of febrile pancytopenia |
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Visceral leishmaniasis: an unexpected diagnosis during the evaluation of pancytopenia in a kidney transplant recipientKidney transplantationliposomal amphotericin Bpancytopeniavisceral leishmaniasisThe aetiological study of cytopenia in solid organ transplant recipients could be challenging, given the need to exclude infectious disorders, drug toxicity or neoplastic disease. Visceral leishmaniasis is endemic in several regions of the world, but a rare complication after renal transplantation (less than 100 cases described in literature). We report the case of a male renal transplant recipient, 57 years of age, admitted to our Unit 17 months after transplantation with febrile illness and severe pancytopenia. He had a history of leucopenia and thrombocytopenia detected in follow-up exams two months earlier, with progressive worsening despite discontinuation of drugs with potential haematologic toxicity. On admission, his complaints were weakness, night sweats and weight loss. On examination, he was febrile, pale, and had a palpable spleen. Laboratory exams demonstrated: leukocytes 1.1 x109/L, platelets 68 x109/L, haemoglobin 10.3 g/dl, serum creatinine 1.48 mg/dl, C-reactive protein 9.72 mg/dl. Abdominal ultrasound confirmed splenomegaly. A bone marrow aspiration was performed and antibiotic therapy was instituted empirically, without improvement. Additional laboratory results were inconclusive: negative blood and urine cultures, no evidence of cytomegalovirus, parvovirus B19 or HIV infections, hepatitis B and C and masses/ adenopathies were excluded by computerized tomography. Despite the absence of an evident epidemiological context, the bone marrow examination showed amastigotes of Leishmania spp. He was started on liposomal amphotericin B (4 mg/kg/day; total of 10 administrations) with a sustained clinical and laboratory improvement after the second day of therapy. Visceral leishmaniasis is a potentially lethal infection if treatment is delayed or not instituted. Although rare among renal transplant recipients it should be included in the differential diagnosis of febrile pancytopeniaSociedade Portuguesa de Nefrologia2013-04-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692013000200008Portuguese Journal of Nephrology & Hypertension v.27 n.2 2013reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692013000200008Pêgo,CRomãozinho,CSantos,LMacário,FAlves,RCampos,MMota,Ainfo:eu-repo/semantics/openAccess2023-07-27T12:22:19ZPortal AgregadorONG |
dc.title.none.fl_str_mv |
Visceral leishmaniasis: an unexpected diagnosis during the evaluation of pancytopenia in a kidney transplant recipient |
title |
Visceral leishmaniasis: an unexpected diagnosis during the evaluation of pancytopenia in a kidney transplant recipient |
spellingShingle |
Visceral leishmaniasis: an unexpected diagnosis during the evaluation of pancytopenia in a kidney transplant recipient Pêgo,C Kidney transplantation liposomal amphotericin B pancytopenia visceral leishmaniasis |
title_short |
Visceral leishmaniasis: an unexpected diagnosis during the evaluation of pancytopenia in a kidney transplant recipient |
title_full |
Visceral leishmaniasis: an unexpected diagnosis during the evaluation of pancytopenia in a kidney transplant recipient |
title_fullStr |
Visceral leishmaniasis: an unexpected diagnosis during the evaluation of pancytopenia in a kidney transplant recipient |
title_full_unstemmed |
Visceral leishmaniasis: an unexpected diagnosis during the evaluation of pancytopenia in a kidney transplant recipient |
title_sort |
Visceral leishmaniasis: an unexpected diagnosis during the evaluation of pancytopenia in a kidney transplant recipient |
author |
Pêgo,C |
author_facet |
Pêgo,C Romãozinho,C Santos,L Macário,F Alves,R Campos,M Mota,A |
author_role |
author |
author2 |
Romãozinho,C Santos,L Macário,F Alves,R Campos,M Mota,A |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Pêgo,C Romãozinho,C Santos,L Macário,F Alves,R Campos,M Mota,A |
dc.subject.por.fl_str_mv |
Kidney transplantation liposomal amphotericin B pancytopenia visceral leishmaniasis |
topic |
Kidney transplantation liposomal amphotericin B pancytopenia visceral leishmaniasis |
description |
The aetiological study of cytopenia in solid organ transplant recipients could be challenging, given the need to exclude infectious disorders, drug toxicity or neoplastic disease. Visceral leishmaniasis is endemic in several regions of the world, but a rare complication after renal transplantation (less than 100 cases described in literature). We report the case of a male renal transplant recipient, 57 years of age, admitted to our Unit 17 months after transplantation with febrile illness and severe pancytopenia. He had a history of leucopenia and thrombocytopenia detected in follow-up exams two months earlier, with progressive worsening despite discontinuation of drugs with potential haematologic toxicity. On admission, his complaints were weakness, night sweats and weight loss. On examination, he was febrile, pale, and had a palpable spleen. Laboratory exams demonstrated: leukocytes 1.1 x109/L, platelets 68 x109/L, haemoglobin 10.3 g/dl, serum creatinine 1.48 mg/dl, C-reactive protein 9.72 mg/dl. Abdominal ultrasound confirmed splenomegaly. A bone marrow aspiration was performed and antibiotic therapy was instituted empirically, without improvement. Additional laboratory results were inconclusive: negative blood and urine cultures, no evidence of cytomegalovirus, parvovirus B19 or HIV infections, hepatitis B and C and masses/ adenopathies were excluded by computerized tomography. Despite the absence of an evident epidemiological context, the bone marrow examination showed amastigotes of Leishmania spp. He was started on liposomal amphotericin B (4 mg/kg/day; total of 10 administrations) with a sustained clinical and laboratory improvement after the second day of therapy. Visceral leishmaniasis is a potentially lethal infection if treatment is delayed or not instituted. Although rare among renal transplant recipients it should be included in the differential diagnosis of febrile pancytopenia |
publishDate |
2013 |
dc.date.none.fl_str_mv |
2013-04-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692013000200008 |
url |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692013000200008 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692013000200008 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
dc.source.none.fl_str_mv |
Portuguese Journal of Nephrology & Hypertension v.27 n.2 2013 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
|
repository.mail.fl_str_mv |
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1777304400656596992 |