|Home | About | Journals | Submit | Contact Us | Français|
A 17-year-old, 37-kg Brazilian man was diagnosed with autoimmune hepatitis at the age of 7 years and underwent liver transplant (cadaveric) at the age of 14. Immunosuppressants included tacrolimus and prednisone. He had lost 3 kg over the previous year and had diarrhea with blood streaks in the previous 3 months but no history of fever. Laboratory tests showed pancytopenia (hemoglobin = 8.1 g/dL; leukocytes = 1,300/mm3; platelets = 79,000/mm3; albumin = 2.7 g/dL). Physical examination showed enlarged liver and spleen. Unrevealing imaging included upper gastroenterointestinal endoscopy, abdominal ultrasound, and computerized tomography of the chest and abdomen (Figure 1) but showed hepatosplenomegaly. Viral serologies were negative. Colonoscopy showed gross nodularity, hyperemia, and friability of the colonic mucosa (Figure 2). Biopsy of terminal ileum region showed amastigote forms of Leishmania inside macrophages (Figure 3A and andB).B). The nature of the agent was confirmed by immunohistochemistry (Figure 3C) and polymerase chain reaction (PCR), which showed L. chagasi infection.1 Examination of a bone-marrow biopsy showed innumerable Leishmania amastigotes (Figure 3D). Serology for leishmaniasis was negative. Treatment with amphotericin B desoxycholate was initiated; renal function deteriorated, and treatment with liposomal amphotericin was substituted (3 mg/kg for 7 days).2 The patient clinically responded with resolution of diarrhea, weight gain, and normalization of spleen size. Two months later, hemoglobin was 11.3 g/dL, leukocytes were 3,670/mm3, platelets were 164,000/mm3, and albumin was 3.8 g/dL.1,2
Authors' addresses: Stanley Almeida Araujo, Thaís Costa Nascentes Queiroz, and Monica Maria Demas Alvares Cabral, Clinics Hospital, Federal University of Minas Gerais, Department of Pathology, Avenida Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil 30130-100, E-mails: moc.liamg@aayelnats, moc.liamg@zorieuqsiaht, and moc.liamtoh@larbacseravlagm.