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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Main Authors: Andreia Costa, Cármen Pais, Sofia Cerqueira, Fernando Salvador
Format: Article
Language:English
Published: Ordem dos Médicos 2018-10-01
Series:Acta Médica Portuguesa
Subjects:
Online Access:https://actamedicaportuguesa.com/revista/index.php/amp/article/view/9028
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spelling 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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