Document Detail

Visceral leishmaniasis and anti-TNF-alpha therapy: case report and review of the literature.
MedLine Citation:
PMID:  19604446     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Visceral leishmaniasis (VL) is an extremely rare example of opportunistic infection in patients treated with TNF-alpha antagonists and only a few cases have been described. In this paper risk factors, clinical features, diagnostic work-up and outcome of patients developing VL under biologic therapy are described. METHODS: Case report and review of the published cases of VL in patients under biologic treatment. RESULTS: We retrieved six patients, including ours, all of whom presented anarchic fever and pancytopenia. In 5 cases, splenomegaly was detected. The same number of patients came from endemic areas for VL. In the majority of the cases a bone marrow examination was not diagnostic, requiring the performance of a second one and/or the execution of other diagnostic tests. One fatal outcome was observed. CONCLUSION: Even if VL represents a sporadic complication of biologic treatments, its presence should always be suspected in patients developing a triad of signs and symptoms constituted by fluctuant fever, pancytopenia and splenomegaly, especially if coming from endemic areas. In these cases an extensive diagnostic work-up must be warranted. Atypical and confusing features may resemble autoimmune diseases at presentation and during the course of the illness.
F De Leonardis; M Govoni; A Lo Monaco; F Trotta
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Clinical and experimental rheumatology     Volume:  27     ISSN:  0392-856X     ISO Abbreviation:  Clin. Exp. Rheumatol.     Publication Date:    2009 May-Jun
Date Detail:
Created Date:  2009-07-16     Completed Date:  2009-10-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8308521     Medline TA:  Clin Exp Rheumatol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  503-6     Citation Subset:  IM    
Section of Rheumatology, Department of Clinical and Experimental Medicine, University of Ferrara, 44100, Ferrara, Italy.
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MeSH Terms
Antibodies, Monoclonal / therapeutic use*
Antirheumatic Agents / therapeutic use*
Arthritis, Psoriatic / drug therapy*
Leishmania donovani
Leishmaniasis, Visceral / diagnosis*,  physiopathology
Middle Aged
Opportunistic Infections / diagnosis*,  physiopathology
Tumor Necrosis Factor-alpha / antagonists & inhibitors*,  physiology
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Antirheumatic Agents; 0/Tumor Necrosis Factor-alpha; 0/infliximab

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