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<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Dear Professor Thiago,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">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.<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">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.<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">With regards,<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Christian Bogdan<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span lang="EN-US" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span lang="EN-GB" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Christian Bogdan, M.D.</span><span lang="EN-US" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D"><o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-GB" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Professor of Medical Microbiology and Infectious Disease Immunology, Head of the Institute<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-GB" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Microbiology Institute – Clinical Microbiology, Immunology and Hygiene</span><span lang="EN-US" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Universitätsklinikum Erlangen<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Friedrich-Alexander Universität Erlangen-Nürnberg<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Wasserturmstraße 3/5<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-GB" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">D-91054 Erlangen, Germany</span><span lang="EN-US" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D"><o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-GB" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Tel. (+49)-9131-852-2551 (office), -2281 (secretary)</span><span lang="EN-US" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D"><o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-GB" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Fax (+49)-9131-852-2573 or -9131-85-1001</span><span lang="EN-US" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">E-mail:
</span><span lang="EN-GB" style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D"><a href="mailto:christian.bogdan@uk-erlangen.de"><span lang="DE" style="color:blue">christian.bogdan@uk-erlangen.de</span></a></span><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">http://www.mikrobiologie.uk-erlangen.de/<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">Von:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> leish-l-bounces@lineu.icb.usp.br [mailto:leish-l-bounces@lineu.icb.usp.br]
<b>Im Auftrag von </b>Igor Thiago Queiroz<br>
<b>Gesendet:</b> Freitag, 11. Juli 2014 01:56<br>
<b>An:</b> Leish-l@lineu.icb.usp.br<br>
<b>Betreff:</b> [Leish-l] Leishmaniasis and Lymphoma<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">Dear all.<o:p></o:p></p>
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<p class="MsoNormal">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. <o:p></o:p></p>
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<p class="MsoNormal">On physical exam he presented mild splenomegaly. Bone marrow aspirate showed some Leishmania sp.<o:p></o:p></p>
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<p class="MsoNormal">However, we decided not to treat this patient because he was symptomless after few days of hospitalization and he was discharged.<o:p></o:p></p>
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<p class="MsoNormal">Some days later, we received bone marrow immunophenotyping compatible with Lymphoma.<o:p></o:p></p>
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<p class="MsoNormal">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?<o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">Abraços,<o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal"><b>Prof. Dr. Igor Thiago</b> Borges de <b>Queiroz</b> e Silva<br>
Infectologista do Hospital Giselda Trigueiro - SESAP - Natal/RN<o:p></o:p></p>
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<p class="MsoNormal">Professor de Infectologia da Universidade Potiguar (UnP) | Laureate International Universities<o:p></o:p></p>
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<p class="MsoNormal"><a href="mailto:igorthiago@usp.br">igorthiago@usp.br</a><o:p></o:p></p>
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<p class="MsoNormal"><a href="mailto:igorthiago@hotmail.com">igorthiago@hotmail.com</a><o:p></o:p></p>
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<p class="MsoNormal">+55 (84) 9608-7999<o:p></o:p></p>
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