engleski

A 9-year-old with fever and severe muscle pains

A previously healthy 9-year-old boy was admitted to hospital with fever, headache, weakness, drowsiness, and rash of 2 days duration. He was lethargic with stiff neck and positive Brudzinski sign. There was a purplish pin-point papular rash over his lower abdomen. Liver and spleen were palpable 2.0 and 2.5 cm below the costal margin. His laboratory findings revealed a moderately accelerated erythrocyte sedimentation, a mild leucopenia, thrombocytopenia, and anemia. His total serum protein was 78 g/L (albumin 46.4%, gamma globulins 28.6%) and lactate dehydrogenase activity 525 IU/L. On the 2nd day in hospital he had severe muscular pains and became bedridden. Assays for Leishmania infantum by indirect haemagglutination showed an antibody titre of 1:8192 and by IFA an IgG titre of 1: 1280. Leishmania amastigotes were not found in bone-marrow aspirate, On day 15, skin and muscle biopsy showed acute dermatomyositis. Treatment with prednisone was started and after a week he improved, became afebrile and mobile. On day 55 he was discharged with maintenance prednisone therapy. Eight months later he was readmitted because he had been found to have a large spleen. This time, serum leishmania IgG antibody titre by IFA was 1:2560 and leishmania amastigotes were found in his bone-marrow aspirate. Treatment with pentavalent antimony derivative was started and improvement in haematological findings and regression of hepatosplenomegaly occurred thereafter. Since myositis and encephalopathy were not known to be manifestations of leishmaniasis, a positive serology was considered to be falsely positive, in spite of other clinical and laboratory features compatibile with leishmaniasis. Unusual leishmanial presentations may be seen more frequently especially in patients living in endemic areas.

myositis; encephalopathy; leishmaniasis

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