AJTMH Transactions of the Royal Society of Tropical Medicine and Hygiene
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Am. J. Trop. Med. Hyg., 79(1), 2008, pp. 9-11
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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CASE REPORT


Distinguishing Visceral Leishmaniasis from Intolerance to Pegylated Interferon-{alpha} in a Thalassemic Splenectomized Patient Treated for Chronic Hepatitis C

Pasquale Pagliano*, Silvia Costantini, Luigi Gradoni, Francesco S. Faella, Anna Spasiano, Giuseppe Mascarella, Luciano Prossomariti, Ugo Fusco, AND Paolo Ricchi
‘D. Cotugno’ Hospital, Department of Emergency, 1st Division of Infectious Diseases, Naples, Italy; ‘A. Cardarelli’ Hospital, Hematology Unit, Naples, Italy; Istituto Superiore di Sanità, Department of Infectious, Parasitic and Immunomediated Diseases, Rome, Italy

 

ABSTRACT

A 37-year-old splenectomized man affected by β-thalassemia and chronic hepatitis, recently treated with pegylated interferon-{alpha} (Peg-IFN), was admitted because of elevated fever lasting 3 months and unresponsiveness to broad-spectrum antibiotics. Laboratory studies showed white blood cell and platelet counts within the normal range but lower than observed before Peg-IFN treatment and an elevated erythrocyte sedimentation rate. The blood transfusion rate was reported to be increased compared with the period preceding Peg-IFN treatment. A diagnosis of visceral leishmaniasis (VL) was made after Leishmania amastigotes were identified from Giemsa-stained smears of bone marrow aspirates. Cure occurred after liposomal amphotericin B was administered. Symptoms of VL may be difficult to distinguish from the manifestations of Peg-IFN intolerance. We suggest that VL must be suspected in any immunodepressed patient with an unexplained fever and a history of exposure in an endemic area.

Received December 3, 2007. Accepted for publication April 8, 2008.

* Address correspondence to Pasquale Pagliano, c/o Ospedale D. Cotugno, I divisione, Via G. Quagliariello 54, 80131 Naples, Italy. E-mail: ppagliano{at}libero.it

Authors’ addresses: Pasquale Pagliano, Francesco S. Faella, Giuseppe Mascarella, and Ugo Fusco, Ospedale D. Cotugno, I divisione, via G. Quagliariello 54, 80131, Naples, Italy. Silvia Costantini, Anna Spasiano, Luciano Prossomariti, and Paolo Ricchi, Ospedale Cardarelli, Thalassemic Unit, via A. Cardarelli 9, 80131, Naples, Italy. Luigi Gradoni, Istituto Superiore di Sanità, Department of Infectious, Parasitic and Immunomediated Diseases, Viale Regina Elena 299, 00161, Rome, Italy.

Reprint requests: Pasquale Pagliano, c/o Ospedale D. Cotugno, I Divisione, Via G. Quagliariello 54, 80131 Naples, Italy, E-mail: ppagliano{at}libero.it.






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