Abstract
Visceral leishmaniasis (VL), a life-threatening parasitic infection, is endemic in the Mediterranean region. Diagnosis of VL is based on epidemiologic, clinical, and laboratory findings. However, sometimes, clinical features and laboratory findings overlap with those of autoimmune diseases. In some cases, autoantibodies are detected in patients with VL and this could be a potential diagnostic pitfall. In this study, we have reported on a three-year-old girl from a VL-endemic area in Iran, who presented with prolonged fever and splenomegaly. Bone marrow examination, serologic tests, and the molecular PCR assay were performed; however, results were inconclusive. The levels of anti-double stranded DNA, cytoplasmic antineutrophil cytoplasmic autoantibody, and perinuclear antineutrophil cytoplasmic autoantibody were elevated and, at the end, splenic biopsy was performed. The splenic tissue PCR test detected the DNA of Leishmania infantum. The patient's condition improved with anti-Leishmania therapy, and the autoantibodies disappeared within the following four months. Clinical presentations and laboratory findings of VL and autoimmune diseases may overlap in some patients.
Highlights
Visceral leishmaniasis (VL) is an endemic parasitic infection, occurring in India, Africa, South America, the Middle East region, and the eastern Mediterranean region
A patient with VL shows a number of clinical features such as fever, malaise, weight loss, and hepatosplenomegaly, as well as some nonspecific laboratory findings like pancytopenia, hypergammaglobulinemia, elevated C-reactive protein (CRP) level, and high erythrocyte sedimentation rate (ESR)
We report the case study of a three-year-old girl with the final diagnosis of visceral leishmaniasis, where autoimmune antibodies in the serum were elevated, resulting in an initial misleading diagnosis
Summary
Visceral leishmaniasis (VL) is an endemic parasitic infection, occurring in India, Africa, South America, the Middle East region, and the eastern Mediterranean region. A patient with VL shows a number of clinical features such as fever, malaise, weight loss, and hepatosplenomegaly, as well as some nonspecific laboratory findings like pancytopenia, hypergammaglobulinemia, elevated C-reactive protein (CRP) level, and high erythrocyte sedimentation rate (ESR). These clinical features and laboratory findings could mimic those of autoimmune diseases [5, 6]. Sometimes, autoantibodies such as antinuclear antibody (ANA), anti-double stranded DNA (anti-dsDNA), cytoplasmic antineutrophil cytoplasmic autoantibody (CANCA), perinuclear antineutrophil cytoplasmic autoantibody (P-ANCA), rheumatoid factor (RF), and anti-smooth muscle antibodies (ASMA) are detected in patients with VL. We report the case study of a three-year-old girl with the final diagnosis of visceral leishmaniasis, where autoimmune antibodies in the serum were elevated, resulting in an initial misleading diagnosis
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