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Indian visceral leishmaniasis with extensive lymphadenopathy – An unusual presentation: A case report with literature review

Visceral leishmaniasis (VL), also known as kala-azar, is a life-threatening systemic disease caused by the obligate intracellular protozoan, Leishmania, and transmitted to humans by the female phlebotomine sand fly (Phlebotomus argentipes). The disease is fatal, if left untreated. We report a case o...

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Autores principales: Agarwal, Poojan, Kumar, Vijay, Kaushal, Manju, Kumari, Manju, Chaudhary, Arvind
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430503/
https://www.ncbi.nlm.nih.gov/pubmed/28567110
http://dx.doi.org/10.4103/1742-6413.205312
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author Agarwal, Poojan
Kumar, Vijay
Kaushal, Manju
Kumari, Manju
Chaudhary, Arvind
author_facet Agarwal, Poojan
Kumar, Vijay
Kaushal, Manju
Kumari, Manju
Chaudhary, Arvind
author_sort Agarwal, Poojan
collection PubMed
description Visceral leishmaniasis (VL), also known as kala-azar, is a life-threatening systemic disease caused by the obligate intracellular protozoan, Leishmania, and transmitted to humans by the female phlebotomine sand fly (Phlebotomus argentipes). The disease is fatal, if left untreated. We report a case of a patient clinically suspected of disseminated tuberculosis, but fine needle aspiration cytology of cervical and axillary lymph nodes yielded a diagnosis of leishmaniasis. Diagnosis of VL was challenging as the disease closely mimicked tuberculosis in the setting of extensive lymphadenopathy including conglomerate of mesenteric lymph nodes, on and off fever, and granulomatous lymphadenitis on aspiration. Bone marrow examination was further performed. A detailed workup revealed patient to be severely immunocompromised and newly diagnosed human immunodeficiency virus (HIV) positive. Worldwide, India has the largest number of VL cases, accounting for 40%–50% of world's disease burden and the second largest HIV-infected population, accounting for approximately 10% of the global disease burden. HIV increases the risk of developing VL by 100–2320 times in endemic areas and concurrently VL promotes the clinical progression of HIV disease. Co-infection with HIV alters the body's immune response to leishmaniasis thus leading to unusual presentations. This case highlights the diagnostic problem in the aforesaid setting. Moreover, co-infection with HIV in VL can be a potential source of drug resistance. An early diagnosis and intensified treatment is the key to patient management.
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spelling pubmed-54305032017-05-31 Indian visceral leishmaniasis with extensive lymphadenopathy – An unusual presentation: A case report with literature review Agarwal, Poojan Kumar, Vijay Kaushal, Manju Kumari, Manju Chaudhary, Arvind Cytojournal Case Report Visceral leishmaniasis (VL), also known as kala-azar, is a life-threatening systemic disease caused by the obligate intracellular protozoan, Leishmania, and transmitted to humans by the female phlebotomine sand fly (Phlebotomus argentipes). The disease is fatal, if left untreated. We report a case of a patient clinically suspected of disseminated tuberculosis, but fine needle aspiration cytology of cervical and axillary lymph nodes yielded a diagnosis of leishmaniasis. Diagnosis of VL was challenging as the disease closely mimicked tuberculosis in the setting of extensive lymphadenopathy including conglomerate of mesenteric lymph nodes, on and off fever, and granulomatous lymphadenitis on aspiration. Bone marrow examination was further performed. A detailed workup revealed patient to be severely immunocompromised and newly diagnosed human immunodeficiency virus (HIV) positive. Worldwide, India has the largest number of VL cases, accounting for 40%–50% of world's disease burden and the second largest HIV-infected population, accounting for approximately 10% of the global disease burden. HIV increases the risk of developing VL by 100–2320 times in endemic areas and concurrently VL promotes the clinical progression of HIV disease. Co-infection with HIV alters the body's immune response to leishmaniasis thus leading to unusual presentations. This case highlights the diagnostic problem in the aforesaid setting. Moreover, co-infection with HIV in VL can be a potential source of drug resistance. An early diagnosis and intensified treatment is the key to patient management. Medknow Publications & Media Pvt Ltd 2017-04-28 /pmc/articles/PMC5430503/ /pubmed/28567110 http://dx.doi.org/10.4103/1742-6413.205312 Text en Copyright: © 2017 Agarwal, et al.; Licensee Cytopathology Foundation Inc. http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Case Report
Agarwal, Poojan
Kumar, Vijay
Kaushal, Manju
Kumari, Manju
Chaudhary, Arvind
Indian visceral leishmaniasis with extensive lymphadenopathy – An unusual presentation: A case report with literature review
title Indian visceral leishmaniasis with extensive lymphadenopathy – An unusual presentation: A case report with literature review
title_full Indian visceral leishmaniasis with extensive lymphadenopathy – An unusual presentation: A case report with literature review
title_fullStr Indian visceral leishmaniasis with extensive lymphadenopathy – An unusual presentation: A case report with literature review
title_full_unstemmed Indian visceral leishmaniasis with extensive lymphadenopathy – An unusual presentation: A case report with literature review
title_short Indian visceral leishmaniasis with extensive lymphadenopathy – An unusual presentation: A case report with literature review
title_sort indian visceral leishmaniasis with extensive lymphadenopathy – an unusual presentation: a case report with literature review
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430503/
https://www.ncbi.nlm.nih.gov/pubmed/28567110
http://dx.doi.org/10.4103/1742-6413.205312
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