P32 | A case of HLH secondary to visceral leishmaniasis in a patient newly diagnosed with Horton’s arteritis

G. Campanaro, A. Ramundo, B. Bartolini, M.C. De Santis, A. Lo Cricchio, G. Bandini | Reparto di Medicina Sperimentale e Clinica, AOUC, Università degli Studi di Firenze, Italy

Premises: An 86 year-old patient suffering from newly diagnosed Horton’s Arteritis accesses the Emergency department for evening fever (40°) with morning defervescence for about four days and rapid worsening of health conditions.
Description of the Case report: Given the presence of fever, splenomegaly, laboratory alterations like cytopenia and hypofibrinogenemia, a diagnosis of hemophagocytic lymphohistiocytosis (HLH) has been hypothesized and confirmed by serum levels of triglycerides and ferritin. The only positive microbiological test is PCR on blood for Leishmania. On the fifth day of hospitalization diagnosis of Visceral Leishmania (VL) complicated by hemophagocytic lymphohistiocytosis was placed. He started high-dose endovenous steroid in association with liposomal amphotericin B.
Conclusions: The early diagnosis of the association between VL and HLH was possible without performing the bone marrow examination: the positivity of PCR test for Leishmania on blood was sufficient because it is highly sensitive and specific and five of eight HLH-2004 diagnostic criteria were present for diagnosis. Our case might suggest clinicians to systematically consider VL and HLH in immunocompromised patients or in patients returning from endemic areas presenting with fever, hepatosplenomegaly, and cytopenia. Given the excellent response to early therapy it is important that the patient undergoes a complete examination of all possible infectious etiologies because, if present, early treatment of the infectious cause with simultaneous immunosuppressive therapy improves the prognosis.