| Sub-title | |
| Author | D Pace |
| Abstract | Visceral leishmaniasis is endemic in the Mediterranean region and is caused by Leishmania infantum. Disease burden is highest in children below the age of 3 years. Autoantibodies might be produced in association with Leishmania infection. Discriminating between infection and autoimmune disease might then be challenging. This is a case report of a 2 year old boy of Afro-Caribbean origin who presented with a four week history of occasional fever and left knee pain. On physical examination he was noted to be pale, had hepatosplenomegaly and a normal left knee. Laboratory investigations showed a hypochromic microcytic anaemia, a raised ESR, a high CRP, and a markedly elevated serum IgG. Cultures of the blood and urine were negative. Serological tests for hepatotropic viruses and HIV were also negative. Rheumatoid factor IgM, anti-dsDNA antibodies and antinuclear antibodies, with a nucleolar pattern, were measured in high titres. Leishmania antibodies were detected by immunofluorescence and intracellular Leishmania amastigotes were identified on examination of a bone marrow aspirate. He was successfully treated with sodium stibogluconate for 3 weeks; however the autoantibodies persisted for up to 4 months later. The production of autoantibodies in visceral leishmaniasis might be secondary to polyclonal B cell activation and molecular mimicry between leishmanial antigens and human proteins. A high index of suspicion is necessary to diagnose this potentially fatal disease. |
Published in: | |
| Journal | Malta Medical Journal |
| Volume | 15 Issue 1-2/suppl. 2003 |
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| Key words | case report, visceral leishmaniasis, autoantibodies |