|IMAGE IN HEMATOLOGY
|Year : 2020 | Volume
| Issue : 3 | Page : 157-158
An unusual finding in peripheral blood: Visceral leishmaniasis
Miguel Aliste-Fernandez, Paula San-José, Luz Muñoz Marín, Granada Perea Durán
Department of Hematology, Clinical Laboratory, Parc Taulí University Hospital, Parc Taulí I3PT Research and Innovation Institute, Autonomous University of Barcelona, Sabadell, Spain
|Date of Submission||18-Sep-2019|
|Date of Decision||24-Jan-2020|
|Date of Acceptance||21-Feb-2020|
|Date of Web Publication||16-Sep-2020|
Dr. Miguel Aliste-Fernandez
Department of Hematology, Clinical Laboratory, Parc Taulí University Hospital, Parc Taulí I3PT Research and Innovation Institute, Autonomous University of Barcelona, Parc Taulí 1, CP: 08208. Sabadell
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Aliste-Fernandez M, San-José P, Marín LM, Durán GP. An unusual finding in peripheral blood: Visceral leishmaniasis. J Appl Hematol 2020;11:157-8
A 43-year-old Nigerian man with a history of human immunodeficiency virus (HIV) infection presented to the emergency department with a 2-month history of asthenia, fever, and nocturnal diaphoresis. Physical examination revealed the presence of lymphadenopathies, splenomegaly, and severe cachexia with malnutrition. Laboratory studies showed pancytopenia and increased acute phase reactants. The bone marrow aspirate smear demonstrated the presence of abundant amastigote forms, and similar intracellular microorganisms were observed in peripheral blood smear inside monocytes and neutrophils [Figure 1]. Serology and confirmatory culture testing of the bone marrow was positive for Leishmania spp. After this finding, the patient was diagnosed with visceral leishmaniasis being treated with amphotericin B with no evidence of infection at discharge.
|Figure 1: Peripheral blood smear shows the presence of intracellular amastigotes forms of Leishmania spp. ([a-c], May-Grünwald-Giemsa, ×1000). Bone marrow aspirate smear demonstrated macrophages with similar intracytoplasmatic and extracellular microorganisms ([d and e], May-Grünwald-Giemsa, ×1000)|
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Leishmaniasis is a disease caused by obligate intracellular protozoa of the genus Leishmania and it is transmitted to humans by the bite of infected female phlebotomine sandflies. In the human host, only the amastigote stage is seen on microscopic examination of tissue specimens, usually in the bone marrow or spleen. Finding these microorganisms in peripheral blood is very rare, but they could be seen in patients with Leishmania/HIV coinfection due to the immunosuppression or in cases of high parasitemia. This case exhibits the importance of careful cytological analysis of the peripheral blood as a first step to establish a correct diagnosis.
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| References|| |
Diro E, Yansouni CP, Takele Y, Mengesha B, Lynen L, Hailu A, et al
. Diagnosis of visceral leishmaniasis using peripheral blood microscopy in Ethiopia: A prospective phase-III study of the diagnostic performance of different concentration techniques compared to tissue aspiration. Am J Trop Med Hyg 2017;96:190-6.