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Case 110

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A 57-year-old female patient, Who was Born and resident in Belo Horizonte, presents with hyporexia, progressive weight loss, prostration, persistent abdominal pain and episodic fever for the last 18 months. Previous laboratory evaluation revealed pancytopenia, elevated liver enzymes and hypoalbuminemia. She reported having dogs and a poultry-yard at home. Findings on examination: pale mucosa, flaky scaling skin, decreased skin turgor and elasticity, a palpable spleen (Boyd type-II) and no lymph node enlargement or fever.

Based on the clinical scenario and images provided, which is the most likely diagnosis?

a) Multiple myeloma

25%

b) Chronic myelomatous leukemia

25%

c) Visceral leishmaniasis

25%

d) Chronic septicemic salmonellosis

25%
   

Comments

- Visceral Leishmaniasis (VL), also known as kala azar, is a systemic infectious disease caused by protozoan parasites of the Leishmania genus.

- It usually has an insidious onset and a chronic course with variable clinical manifestations, making its diagnosis challenging.

- The diagnostic method of reference remains preferentially the demonstration of Leishmania amastigotes in the bone-marrow aspiration smears.

- It is an endemic disease in South and Central America which has recently been spreading to urban areas.

- The diagnosis should be set as fast as possible and proper treatment with pentavalent antimony or amphotericin B needs to be readily available.

References

- Pastorino AC, et al. Visceral leishmaniasis: clinical and laboratorial aspects. Jornal de Pediatria. 2002, Jan; 78:120-7.

- Oliveira JM, et al.Mortality due to visceral leishmaniasis: clinical and laboratory characteristics. Revista da Sociedade Brasileira de Medicina Tropical. 2010 mar-abr; 43(2):188-193.

- Leishmaniose visceral : recomendações clínicas para redução da letalidade. Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. – Brasília : Ministério da Saúde, 2011.

Authors

- Juliana da Cunha Pimentel Ulhôa - 6th year medical student of UFMG School of Medicine

E-mail: ju_ulhoa[at]hotmail.com

- Rodolfo Paro - 6th year medical student of UFMG School of Medicine

E-mail: rodparo[at]hotmail.com

Supervisors

- Professor Ana Lúcia Cândido – member of the Department of Internal Medicine (UFMG School of Medicine).

E-mail: acandido[at]medicina.ufmg.br

- Professor Luciana Diniz Silva – member of the Department of Internal Medicine (UFMG School of Medicine).

E-mail: lucianadinizsilva[at]gmail.com

Reviewers

Reanto Campanati, Raphael Penholati and Professor Viviane Parisotto

Acknowledgements

Daniel Dias do Carmo and Maria Marta Figueiredo for providing us with the images reproduced herein.

Translated by

Lucas Resende Lucinda, 6th year medical student of UFMG School of Medicine.
E-mail: lucasresendebh[at]hotmail.com

 

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