[Leish-l] Leishmaniasis and Lymphoma

[Bogdan, Christian]

Dear Professor Thiago,

I would strongly recommend to treat this patient for visceral leishmaniasis (we would use liposomal amphotericin B) before treating the presumed lymphoma, especially because he has had clear symptoms and signs of disease and lymphoma treatment bears the risk of VL aggravation. The fact that the patient´s fever intermittently resolved does not mean anything with respect to the further course of the infection.
Concerning the lymphoma diagnosis based on “immunophenotyping” I would question this diagnosis as long as the VL has not been treated and the diagnosis has not been ascertained by proving clonality with molecular techniques, because VL is known to cause e.g. polyclonal B cell activation and proliferation. Of course, chronic VL can also cause the development of true lymphoma, but I would consider this as a rare event. Much more likely is that the so-called lymphoma is a non-malignant lymphoproliferation due to visceral leishmaniasis.

With regards,

Christian Bogdan


Christian Bogdan, M.D.
Professor of Medical Microbiology and Infectious Disease Immunology, Head of the Institute
Microbiology Institute – Clinical Microbiology, Immunology and Hygiene
Universitätsklinikum Erlangen
Friedrich-Alexander Universität Erlangen-Nürnberg
Wasserturmstraße 3/5
D-91054 Erlangen, Germany
Tel. (+49)-9131-852-2551 (office), -2281 (secretary)
Fax (+49)-9131-852-2573 or -9131-85-1001
E-mail: christian.bogdan at uk-erlangen.de<mailto:christian.bogdan at uk-erlangen.de>
http://www.mikrobiologie.uk-erlangen.de/


Von: leish-l-bounces at lineu.icb.usp.br [mailto:leish-l-bounces at lineu.icb.usp.br] Im Auftrag von Igor Thiago Queiroz
Gesendet: Freitag, 11. Juli 2014 01:56
An: Leish-l at lineu.icb.usp.br
Betreff: [Leish-l] Leishmaniasis and Lymphoma

Dear all.
We have an adult male patient, which presented some symptoms like fever, malaise, abdominal pain and weight loss for 15 days, and fever has disappeared posteriorly.
On physical exam he presented mild splenomegaly. Bone marrow aspirate showed some Leishmania sp.
However, we decided not to treat this patient because he was symptomless after few days of hospitalization and he was discharged.
Some days later, we received bone marrow immunophenotyping compatible with Lymphoma.
What should we do now? Treat this patient for leishmaniasis before therapy for cancer? With Ambisome? Or should we expect the patient has some leishmaniasis symptoms before specific treatment?


Abraços,

Prof. Dr. Igor Thiago Borges de Queiroz e Silva
Infectologista do Hospital Giselda Trigueiro - SESAP - Natal/RN
Professor de Infectologia da Universidade Potiguar (UnP) | Laureate International Universities
igorthiago at usp.br<mailto:igorthiago at usp.br>
igorthiago at hotmail.com<mailto:igorthiago at hotmail.com>
+55 (84) 9608-7999


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