Visceral leishmaniasis with multiple splenic nodular lesions

An 81-year-old male patient presented with fever, weight loss, and abdominal distension at the hospital. Physical examination revealed marked splenomegaly and emaciation. The hematological study showed pancytopenia (hemoglobin: 7.5 g/dl, leukocyte count: 620/mm³, and platelets: 57,000/mm³), and serum albumin level (2.5 g/dl) was below normal. Laboratory tests were negative for anti-human immunodeficiency virus (HIV)-1, anti-HIV-2, hepatitis B virus surface antigen, anti-hepatitis C virus, and venereal disease and positive for recombinant K39 antigen. Patient was diagnosed with visceral leishmaniasis based on clinical and laboratory findings. Contrast-enhanced T1-weighted magnetic resonance imaging of the abdomen revealed an enlarged spleen with multiple hypointense nodules throughout the splenic parenchyma with perilesional enhancement (Figure 1A-C, white arrows). The patient received liposomal amphotericin B (3 mg/kg/day) for seven days. Twenty days after starting the treatment, he was discharged with marked improvement in the clinical symptoms and without any hematological alterations. Splenic lesions disappeared after amphotericin therapy.

FIGURE 1:
Magnetic resonance imaging enlarged spleen. (A-B): Contrast-enhanced T1-weighted sequence of the abdominal axial plane revealing multiple hypointense nodular lesions with perilesional enhancement (white arrows) in the superior part of the spleen. (C): Contrast-enhanced T1-weighted sequence of the abdominal coronal plane, revealing similar lesions (white arrows) mainly in the superior part of the spleen.

Similar cases of nodular lesions in the spleen related to visceral leishmaniasis have been reported in the literature. However, this manifestation appears to be rare^1,2. The main differential diagnosis was lymphoma, tuberculosis, and fungal infections. It is probable that the hypointense nodules represent the amastigote form of Leishmania, as previously reported by Bükte et al³. A limitation of our case report was that the histopathological study was not performed due to its invasive nature and the risk to the patient. The possibility of visceral leishmaniasis should be considered in the differential diagnosis of multiple nodules in the spleen.

ACKNOWLEDGMENTS

We thank the patient who agreed to participate in the study and all the staff of Hospital Universitário Walter Cantídeo.

REFERENCES

• ¹
  Raeymaeckers S, Docx M, Demeyere N. MRI-findings of nodular lesions in an enlarged spleen, associated with visceral Leishmaniasis. Eur J Radiol. 2012;81(10):2550-3.
• ²
  Mao G, Yang G, Cheng Y, Zee CS, Huang W, Ni W, et al. Multiple nodular lesions in spleen associated with visceral leishmaniasis. Medicine 2014;93(29):e272.
• ³
  Bükte Y, Nazaroglu H, Mete A, Yilmaz F. Visceral leishmaniasis with multiple nodular lesions of the liver and spleen: CT and sonographic findings. Abdom Imaging. 2004;29(1):82-4.

Publication Dates

• Publication in this collection
  03 Oct 2019
• Date of issue
  2019

History

• Received
  15 June 2019
• Accepted
  02 Aug 2019