Case Report

Disseminated Leishmaniasis Due to Using Immunosuppression Drugs: A Case Report

Abstract

Visceral leishmaniasis is a common parasitic disease between humans and animals, transmitted by sandflies (Phlebotomus) in the Mediterranean countries, including Iran. The statistics have been reported less than real due to errors in the diagnosis and reporting of affected cases. In this report, we will present the symptoms and manifestations of this disease to reduce late detection and exacerbating factors. The patient was a three-year-old girl from Tehran, Iran who had ascites and hepatomegaly. When she was 9 month-old, she was diagnosed as autoimmune hepatitis after liver biopsy and she was treated with immunosuppressive drugs (Azathioprine, prednisolone, and cyclosporine) for 22 months, but later she suffered from fever, pancytopenia, and hepatosplenomegaly. Then a bone marrow biopsy was done for her. There was a large amount of Leishman body in her bone marrow and treatment for Kala-azar was started for her. In patients with prolonged fever and splenomegaly, especially association with pancytopenia, consider leishmaniasis. Immunosuppressive drugs can disseminate parasitic diseases, including visceral leishmaniasis.

1. Goldman B, Ausiello DA. CECLIL Textbook of Medicine. 25th ed. Philadelphia: USA; 2016.
2. Chouchene S, Braham N, A Bouatay et al. [Hema-tologic abnormalities in infantile visceral leishmania-sis]. Arch Pediator.2015; (11): 1107-11. [Article in French]
3. Hashemi S, HaghAzali M. Visceral Leishmaniosis that presented with fever and bloody diarrhea “a case report”. RJMS. 2003; 10 (33) :151-157.
4. Mahmoud Khodabandeh, Ali Rostami, Katayoun Borhani, et al. Treatment of resistant visceral leish-maniasis with interferon gamma in combination with liposomal amphotericin B and allopurinol. Par-asitol Int. 2019; 72:101934.
5. Fakhar M, Ahmadpour E. An Overview of the Laboratory Diagnostic Procedures of Visceral Leishmaniasis (Kala-Azar). MLJ. 2013; 7 (1): 45-54.
6. Sarkari B, Rezaei Z, Mohebali M. Immunodiagnosis of Visceral Leishmaniasis: Current Status and Chal-lenges: A Review Article. Iran J Parasitol. 2018; 13 (3): 331-341.
7. Cruz-López O1, Tamariz-Cruz O, Gándara-Ramírez JL, et al. A case of visceral leishmaniasis. Rev Linvest Clin.1997; 49 (3): 231-5.
8. Mohebali M. Visceral leishmaniasis in Iran: Review of the Epidemiological and Clinical Feature. Iran J Parasitol: 2013; 8 (3): p.348-358.
9. A Nadrid, H Pousse, Laradi-Chebil, et al. [Infantile visceral leishmaniasis: difficult diagnosis in cases complicated by hemophagocytosis]. Arch Pediatr. 1996; 3(9): 881-883. [Article in French]
10. Nafil H, Tazi I, Mahmal L. Association of Acute Lymphoblastic Leucomia and Visceral Leishmania-sis. An Biol Clin (Paris). 2011; 69 (6): 729-31.
11. Lorusso V, Dantas-Torres F, Caprio F, et al. Pediat-ric Visceral Leishmaniasis in Itali: A'one Health's Approach is Needed. Parasites & Vectors . 2013; 6: 123.
12. Varma N, Naseem S. Hematologic changes in visceral leishmaniasis / kala-azar. Indian J Hematol Blood Transfus. 2010; 26 (3): 78-82.
13. Mohebali M, Edrissian Gh H, Nadim A, et al. Ap-plication of direct agglutination test (DAT) for the diagnosis and seroepidemiological studies of viscer-al leishmaniasis in Iran. Iran J Parasitol. 2006; 1: 15- 25.
Files
IssueVol 15 No 2 (2020) QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/ijpa.v15i2.3312
Keywords
Visceral leishmaniasis Splenomegaly Pancytopenia Iran

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
AFSHOON M, ABDOLSALEHI M, ALINIA G, BORHANI K, YAGHMAIE B, KHODABANDEH M. Disseminated Leishmaniasis Due to Using Immunosuppression Drugs: A Case Report. Iran J Parasitol. 2020;15(2):278-281.