Hemophagocytic syndrome associated with leishmaniasis: case report

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Abstract

Secondary hemophagocytic syndrome (sHLH) is a hyperinflammatory reaction which manifests with fever, cytopenia and organ damage. possible causes of sHLH include leishmaniasis.  The article describes a clinical case of sHLH in patient with visceral leishmaniasis. A female 30 years old developed hectic daily fever up to 40 °C, pancytopenia, cytolytic syndrome, hyperferritin- and hypertriglyceridemia, immunoglobulin G to capsid antigens of the Epstein-Barr virus, enlarged liver and spleen a one and a half month after returning from Spain. based on the HLH-2004 and H-Score criteria, a sHLH was diagnosed, presumably associated with the Epstein-Barr virus. Immunosuppressive treatment with dexamethasone, cyclosporin-A and etoposide was started under the HLH-2004 program. Apyrexia, reduction of splenomegaly and resolution of cytolysis were achieved. The fever resumed 20 days after the start of chemotherapy, the spleen enlarged again, and therefore a diagnostic splenectomy was performed. Morphological analysis of the removed spleen revealed leishmania. After amphotericin-B therapy, the patient recovered.  Chemotherapy of sHLH led to a temporary improvement for a period sufficient to verify the diagnosis and conducting of successful treatment.

About the authors

V. G. Potapenko

City Clinical Hospital No. 31

Author for correspondence.
Email: potapenko.vsevolod@mail.ru
ORCID iD: 0000-0003-2985-0503

Vsevolod G. Potapenko.

3 Prospekt Dinamo, Saint-Petersburg 197110.

Russian Federation

M. M. Antonov

S.P. Botkin Clinical Hospital of Infectious Diseases

3 Mirgorodskaya St., Saint-Petersburg 191167.

Russian Federation

N. V. Vinogradova

S.P. Botkin Clinical Hospital of Infectious Diseases

3 Mirgorodskaya St., Saint-Petersburg 191167.

Russian Federation

E. V. Doguzhieva

S.P. Botkin Clinical Hospital of Infectious Diseases

3 Mirgorodskaya St., Saint-Petersburg 191167.

Russian Federation

V. E. Karev

Children's Scientific and Clinical Center for Infectious Diseases, Federal Medical and Biological Agency

ORCID iD: 0000-0002-7972-1286

9 Professora Popova St., Saint-Petersburg 197022.

Russian Federation

E. S. Karamurzin

I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia

41 Kirochnaya St., Saint-Petersburg 191015.

Russian Federation

G. V. Kachenya

S.P. Botkin Clinical Hospital of Infectious Diseases

3 Mirgorodskaya St., Saint-Petersburg 191167.

Russian Federation

A. V. Klimovich

City Clinical Hospital No. 31

ORCID iD: 0000-0002-9890-0108

3 Prospekt Dinamo, Saint-Petersburg 197110.

Russian Federation

S. S. Kozlov

S.M. Kirov Military Medical Academy, Ministry of Defense of Russia

ORCID iD: 0000-0003-0632-7306

6 Akademika Lebedeva St., Saint-Petersburg 194044.

Russian Federation

Yu. A. Krivolapov

I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia

ORCID iD: 0000-0002-9872-0326

41 Kirochnaya St., Saint-Petersburg 191015.

Russian Federation

S. V. Lapin

I.P. Pavlov First Saint-Petersburg State Medical University, Ministry of Health of Russia

ORCID iD: 0000-0002-4998-3699

6—8 L’va Tolstogo St., Saint-Petersburg 197022.

Russian Federation

M. Yu. Pervakova

I.P. Pavlov First Saint-Petersburg State Medical University, Ministry of Health of Russia

ORCID iD: 0000-0001-9630-257X

6—8 L’va Tolstogo St., Saint-Petersburg 197022.

Russian Federation

N. A. Potikhonova

Russian Research Institute of Hematology and Transfusiology, Federal Medical and Biological Agency

16 2nd Sovetskaya St., Saint-Petersburg 191024.

Russian Federation

I. P. Fedunyak

S.P. Botkin Clinical Hospital of Infectious Diseases; I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia

3 Mirgorodskaya St., Saint-Petersburg 191167; 41 Kirochnaya St., Saint-Petersburg 191015.

Russian Federation

N. V. Medvedeva

City Clinical Hospital No. 31

ORCID iD: 0000-0002-4350-4204

3 Prospekt Dinamo, Saint-Petersburg 197110.

Russian Federation

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