Visceral Leishmaniasis Associated with Macrophage Activation Syndrome and Diffuse Alveolar Hemorrhage in a Lupus Patient
Systemic lupus erythematosus is a heterogeneous and unpredictable autoimmune disease which can be complicated to approach and treat. Hemophagocytic lymphohistiocytosis and diffuse alveolar hemorrhage are rare disease complications. The authors describe a clinical case of a 32-year-old woman with lup...
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2018-10-01
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doaj-33670f6909a04f9fbfd8ef9d76b13e052020-11-25T01:28:36ZengOrdem dos MédicosActa Médica Portuguesa0870-399X1646-07582018-10-01311059359610.20344/amp.90284782Visceral Leishmaniasis Associated with Macrophage Activation Syndrome and Diffuse Alveolar Hemorrhage in a Lupus PatientAndreia Costa0Cármen Pais1Sofia Cerqueira2Fernando Salvador3Serviço de Medicina Interna. Centro Hospitalar de Trás-os-Montes e Alto Douro. Vila Real.Serviço de Medicina Interna. Centro Hospitalar de Trás-os-Montes e Alto Douro. Vila Real.Serviço de Medicina Interna. Centro Hospitalar de Trás-os-Montes e Alto Douro. Vila Real.Serviço de Medicina Interna. Centro Hospitalar de Trás-os-Montes e Alto Douro. Vila Real.Systemic lupus erythematosus is a heterogeneous and unpredictable autoimmune disease which can be complicated to approach and treat. Hemophagocytic lymphohistiocytosis and diffuse alveolar hemorrhage are rare disease complications. The authors describe a clinical case of a 32-year-old woman with lupus and fever of unknown origin. From the investigations performed, the myelogram revealed hemophagocytosis and Leishmania parasites, therefore liposomal amphotericin B was then started. In addition to directed therapy, she maintained fever that evolved with diffuse alveolar hemorrhage. The myelogram was repeated and showed that she still had hemophagocytosis but now without parasites. Corticotherapy was increased and intravenous Immunoglobulin was started, with improvement. Rituximab was started as a result of macrophage activation syndrome and diffuse alveolar hemorrhage. Months after discharge, she began once again to have sustained fever and Leishmania parasites were found again, therefore liposomal amphotericin B was started once more associated with miltefosine. She continues being followed-up as she is asymptomatic and using steroids in weaning scheme.https://actamedicaportuguesa.com/revista/index.php/amp/article/view/9028Leishmaniasis, VisceralLung DiseasesLymphohistiocytosis, HemophagocyticLupus Erythematosus, Systemic/complicationsMacrophage Activation SyndromeTreatment Outcome |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Andreia Costa Cármen Pais Sofia Cerqueira Fernando Salvador |
spellingShingle |
Andreia Costa Cármen Pais Sofia Cerqueira Fernando Salvador Visceral Leishmaniasis Associated with Macrophage Activation Syndrome and Diffuse Alveolar Hemorrhage in a Lupus Patient Acta Médica Portuguesa Leishmaniasis, Visceral Lung Diseases Lymphohistiocytosis, Hemophagocytic Lupus Erythematosus, Systemic/complications Macrophage Activation Syndrome Treatment Outcome |
author_facet |
Andreia Costa Cármen Pais Sofia Cerqueira Fernando Salvador |
author_sort |
Andreia Costa |
title |
Visceral Leishmaniasis Associated with Macrophage Activation Syndrome and Diffuse Alveolar Hemorrhage in a Lupus Patient |
title_short |
Visceral Leishmaniasis Associated with Macrophage Activation Syndrome and Diffuse Alveolar Hemorrhage in a Lupus Patient |
title_full |
Visceral Leishmaniasis Associated with Macrophage Activation Syndrome and Diffuse Alveolar Hemorrhage in a Lupus Patient |
title_fullStr |
Visceral Leishmaniasis Associated with Macrophage Activation Syndrome and Diffuse Alveolar Hemorrhage in a Lupus Patient |
title_full_unstemmed |
Visceral Leishmaniasis Associated with Macrophage Activation Syndrome and Diffuse Alveolar Hemorrhage in a Lupus Patient |
title_sort |
visceral leishmaniasis associated with macrophage activation syndrome and diffuse alveolar hemorrhage in a lupus patient |
publisher |
Ordem dos Médicos |
series |
Acta Médica Portuguesa |
issn |
0870-399X 1646-0758 |
publishDate |
2018-10-01 |
description |
Systemic lupus erythematosus is a heterogeneous and unpredictable autoimmune disease which can be complicated to approach and treat. Hemophagocytic lymphohistiocytosis and diffuse alveolar hemorrhage are rare disease complications. The authors describe a clinical case of a 32-year-old woman with lupus and fever of unknown origin. From the investigations performed, the myelogram revealed hemophagocytosis and Leishmania parasites, therefore liposomal amphotericin B was then started. In addition to directed therapy, she maintained fever that evolved with diffuse alveolar hemorrhage. The myelogram was repeated and showed that she still had hemophagocytosis but now without parasites. Corticotherapy was increased and intravenous Immunoglobulin was started, with improvement. Rituximab was started as a result of macrophage activation syndrome and diffuse alveolar hemorrhage. Months after discharge, she began once again to have sustained fever and Leishmania parasites were found again, therefore liposomal amphotericin B was started once more associated with miltefosine. She continues being followed-up as she is asymptomatic and using steroids
in weaning scheme. |
topic |
Leishmaniasis, Visceral Lung Diseases Lymphohistiocytosis, Hemophagocytic Lupus Erythematosus, Systemic/complications Macrophage Activation Syndrome Treatment Outcome |
url |
https://actamedicaportuguesa.com/revista/index.php/amp/article/view/9028 |
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