- Email: [email protected]
Response to a letter to the editor entitled “A Case of Leishmaniasis With Lupus-Like Presentation”
Seminars in Arthritis and Rheumatism 45 (2015) e5
Contents lists available at ScienceDirect
Seminars in Arthritis and Rheumatism journal homepage: www.elsevier.com/locate/semarthrit
Response to a letter to the editor entitled “A Case of Leishmaniasis With Lupus-Like Presentation”
reported case. This clinical scenario associated to the production of autoantibodies may lead to misdiagnosis of autoimmune diseases. Thus, one needs to be aware of these clinical and laboratory key points to avoid life-threatening exposure to immunosuppressive therapy, particularly in endemic area for VL.
Dear Editor,
References
We appreciate the interest of the authors in our article [1] by publishing a Letter to the Editor entitled “A Case of Leishmaniasis with a Lupus-Like Presentation.” The authors report a case of visceral leishmaniasis (VL) with clinical findings mimicking systemic lupus erythematosus (SLE), which is in total agreement with the results of our study. They report a case of a 21-year-old man who presented the following set of signs and symptoms: intermittent fever, fatigue, weight loss, massive splenomegaly, lymphadenopathy, and bone pain (with no arthritis). Furthermore, the following laboratory abnormalities were observed: increased serum level of C-reactive protein (CRP), pancytopenia, polyclonal gammopathy, hyperferritinemia, and the presence of autoantibodies. In our study [1], we pointed out that some findings may be shared by the two conditions such as intermittent fever, cytopenias, polyclonal gammopathy, bone pain/arthralgia, presence of autoantibodies, and even renal abnormalities. On the other hand, we also emphasized that some findings may corroborate the suspicious of VL instead of SLE, such as organomegaly (mostly massive splenomegaly), high values of CRP, normal complement serum levels, and the lack of response to steroids. Organomegaly and lymphadenopathy in VL are often due to the involvement of the reticuloendothelial system [2], and VL may lead to macrophage activation syndrome [3], as it was suspected in the
[1] Santana IU, Dias B, Nunes EA, Rocha FA, Silva FSFS Jr, Santiago MB. Visceral leishmaniasis mimicking systemic lupus erythematosus: case series and a systematic literature review. Semin Arthritis Rheum 2014 [Epub 2015/02/24]. [2] Georgiadou SP, Stefos A, Spanakos G, Skrimpas S, Makaritsis K, Sipsas NV, et al. Current clinical, laboratory, and treatment outcome characteristics of visceral leishmaniasis: results from a seven-year retrospective study in Greece. Int J Infect Dis 2015 [Epub 2015/03/07]. [3] Ferreira DG, do Val Rezende P, Murao M, Viana MB, de Oliveira BM. Hemophagocytic lymphohistiocytosis: a case series of a Brazilian institution. Rev Bras Hematol Hemoter 2014;36:437–41 [Epub 2014/12/03].
DOI of original article: http://dx.doi.org/10.1016/j.semarthrit.2015.04.001 http://dx.doi.org/10.1016/j.semarthrit.2015.04.007 0049-0172/& 2015 Elsevier Inc. All rights reserved.
Iuri Usêda Santana Servic¸o de Clı´nica Me´dica do Hospital Geral Roberto Santos Salvador, Brazil
Blenda Dias, Eduardo Araújo Santana Nunes Mittermayer Barreto Santiago Servic¸os Especializados em Reumatologia (SER) da Bahia Rua Conde Filho, 117, Grac¸a, Salvador, Bahia CEP 40150-150, Brazil E-mail address: [email protected] (M.B. Santiago) Francisco Airton Castro da Rocha, Francisco Saraiva Silva Jr Servic¸o de Reumatologia do Hospital Universita´rio Walter Cantı´dio, Ceara´, Brazil
Contents lists available at ScienceDirect
Seminars in Arthritis and Rheumatism journal homepage: www.elsevier.com/locate/semarthrit
Response to a letter to the editor entitled “A Case of Leishmaniasis With Lupus-Like Presentation”
reported case. This clinical scenario associated to the production of autoantibodies may lead to misdiagnosis of autoimmune diseases. Thus, one needs to be aware of these clinical and laboratory key points to avoid life-threatening exposure to immunosuppressive therapy, particularly in endemic area for VL.
Dear Editor,
References
We appreciate the interest of the authors in our article [1] by publishing a Letter to the Editor entitled “A Case of Leishmaniasis with a Lupus-Like Presentation.” The authors report a case of visceral leishmaniasis (VL) with clinical findings mimicking systemic lupus erythematosus (SLE), which is in total agreement with the results of our study. They report a case of a 21-year-old man who presented the following set of signs and symptoms: intermittent fever, fatigue, weight loss, massive splenomegaly, lymphadenopathy, and bone pain (with no arthritis). Furthermore, the following laboratory abnormalities were observed: increased serum level of C-reactive protein (CRP), pancytopenia, polyclonal gammopathy, hyperferritinemia, and the presence of autoantibodies. In our study [1], we pointed out that some findings may be shared by the two conditions such as intermittent fever, cytopenias, polyclonal gammopathy, bone pain/arthralgia, presence of autoantibodies, and even renal abnormalities. On the other hand, we also emphasized that some findings may corroborate the suspicious of VL instead of SLE, such as organomegaly (mostly massive splenomegaly), high values of CRP, normal complement serum levels, and the lack of response to steroids. Organomegaly and lymphadenopathy in VL are often due to the involvement of the reticuloendothelial system [2], and VL may lead to macrophage activation syndrome [3], as it was suspected in the
[1] Santana IU, Dias B, Nunes EA, Rocha FA, Silva FSFS Jr, Santiago MB. Visceral leishmaniasis mimicking systemic lupus erythematosus: case series and a systematic literature review. Semin Arthritis Rheum 2014 [Epub 2015/02/24]. [2] Georgiadou SP, Stefos A, Spanakos G, Skrimpas S, Makaritsis K, Sipsas NV, et al. Current clinical, laboratory, and treatment outcome characteristics of visceral leishmaniasis: results from a seven-year retrospective study in Greece. Int J Infect Dis 2015 [Epub 2015/03/07]. [3] Ferreira DG, do Val Rezende P, Murao M, Viana MB, de Oliveira BM. Hemophagocytic lymphohistiocytosis: a case series of a Brazilian institution. Rev Bras Hematol Hemoter 2014;36:437–41 [Epub 2014/12/03].
DOI of original article: http://dx.doi.org/10.1016/j.semarthrit.2015.04.001 http://dx.doi.org/10.1016/j.semarthrit.2015.04.007 0049-0172/& 2015 Elsevier Inc. All rights reserved.
Iuri Usêda Santana Servic¸o de Clı´nica Me´dica do Hospital Geral Roberto Santos Salvador, Brazil
Blenda Dias, Eduardo Araújo Santana Nunes Mittermayer Barreto Santiago Servic¸os Especializados em Reumatologia (SER) da Bahia Rua Conde Filho, 117, Grac¸a, Salvador, Bahia CEP 40150-150, Brazil E-mail address: [email protected] (M.B. Santiago) Francisco Airton Castro da Rocha, Francisco Saraiva Silva Jr Servic¸o de Reumatologia do Hospital Universita´rio Walter Cantı´dio, Ceara´, Brazil