Bode, Sebastian F. N. and Bogdan, Christian and Beutel, Karin and Behnisch, Wolfgang and Greiner, Jeanette and Henning, Stephan and Jorch, Norbert and Jankofsky, Martin and Jakob, Marcus and Schmid, Irene and Veelken, Norbert and Vraetz, Thomas and Janka, Gritta and Ehl, Stephan and Lehmberg, Kai (2014) Hemophagocytic Lymphohistiocytosis in Imported Pediatric Visceral Leishmaniasis in a Nonendemic Area. JOURNAL OF PEDIATRICS, 165 (1). 147-+. ISSN 0022-3476, 1097-6833
Full text not available from this repository. (Request a copy)Abstract
Objectives To describe characteristics of visceral leishmaniasis-associated hemophagocytic lymphohistiocytosis (HLH) with focus on diagnostic clues and pitfalls, including the frequency of central nervous system (CNS) involvement, and to determine the efficacy of liposomal amphotericin B (L-AmB). Study design We retrospectively analyzed clinical and laboratory features, diagnostic procedures, and treatment of 13 patients with HLH with imported visceral leishmaniasis, reported to the German HLH reference center (1999-2012). Results The spectrum of presentations was indistinguishable from patients with hereditary HLH or with acquired HLH because of infections with other pathogens. In 8 patients, disease onset occurred before the age of 2 years, coinciding with the typical age of manifestation of primary HLH. Two patients had mild nonspecific CNS findings. Misleading antiviral IgM (n = 6) and autoantibodies (n = 2) led to inaccurate interpretation of the etiology of HLH, sometimes with inappropriate therapeutic consequences. False negative results for Leishmania were obtained by initial bone marrow microscopy in 6/13, serology in 1/12, bone marrow culture in 2/5, and polymerase chain reaction of peripheral blood in 1/3 patients, and all bone marrow samples tested were Leishmania-positive by polymerase chain reaction (n = 7). L-AmB was administered to 12 patients, 5 of whom had no prior HLH-directed immunosuppressive therapy; sodium stibogluconate was administered to 1 patient. Persistent remission was achieved in 11 cases. Two patients required repeated or prolonged L-AmB therapy. Conclusions Awareness of diagnostic pitfalls may save patients from unnecessary toxic treatment. CNS involvement is rare. L-AmB shows efficacy in visceral leishmaniasis-associated HLH.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | LIPOSOMAL AMPHOTERICIN-B; DIAGNOSIS; CHILDREN; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Abteilung für Pädiatrische Hämatologie, Onkologie und Stammzelltransplantation |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 08 Oct 2019 13:27 |
| Last Modified: | 08 Oct 2019 13:27 |
| URI: | https://pred.uni-regensburg.de/id/eprint/9922 |
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