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Kala‐azar in a one‐year‐old Swedish child. Diagnostic difficulties because of active hemophagocytosis
Author(s) -
Granert Carl,
Elinder Göran,
Öst Åke,
Henter JanInge
Publication year - 1993
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.1993.tb12562.x
Subject(s) - hemophagocytosis , medicine , cytopenia , hemophagocytic lymphohistiocytosis , sodium stibogluconate , visceral leishmaniasis , bone marrow , leishmaniasis , spleen , fever of unknown origin , differential diagnosis , pathology , immunology , pediatrics , surgery , pancytopenia , disease
A one‐year‐old Swedish boy developed kala‐azar six months after a holiday in Spain. Upon visiting the hospital after one week of illness he demonstrated clinical and laboratory findings of fever, splenomegaly and cytopenia. A fine‐needle aspiration biopsy of the spleen revealed hemophagocytosis and he had increased serum levels of the cytokines tumor necrosis factor‐alpha and interferon‐gamma. Initially, a diagnosis of hemophagocytic lymphohistiocytosis was made. Re‐evaluation of the spleen smears and of the bone marrow aspiration revealed Leishmania parasites and subsequent therapy with sodium stibogluconate was successful. This patient illustrates the interesting similarities between these two disorders involving the mononuclear phagocyte system as well as the problems involved in differential diagnosis. This case also reminds us of the possibility of contracting visceral leishmaniasis in Mediterranean countries.