Distinguishing visceral leishmaniasis from intolerance to pegylated interferon-alpha in a thalassemic splenectomized patient treated for chronic hepatitis C.

A 37-year-old splenectomized man affected by beta-thalassemia and chronic hepatitis, recently treated with pegylated interferon-alpha (Peg-IFN), was admitted because of elevated fever lasting 3 months and unresponsiveness to broad-spectrum antibiotics. Laboratory studies showed white blood cell and platelet counts within the normal range but lower than observed before Peg-IFN treatment and an elevated erythrocyte sedimentation rate. The blood transfusion rate was reported to be increased compared with the period preceding Peg-IFN treatment. A diagnosis of visceral leishmaniasis (VL) was made after Leishmania amastigotes were identified from Giemsa-stained smears of bone marrow aspirates. Cure occurred after liposomal amphotericin B was administered. Symptoms of VL may be difficult to distinguish from the manifestations of Peg-IFN intolerance. We suggest that VL must be suspected in any immunodepressed patient with an unexplained fever and a history of exposure in an endemic area.

[Non post-operative spondylodiskitis. Our experience during the period 1990-2001]. / Spondilodisciti non chirurgiche. Casistica degli anni 1990-2001.

UNLABELLED: Aim of the study was to evaluate the prevalence and characteristics of non operative spondylodiskitis (SD) in our geographic area. METHODS: We evaluated retrospectively epidemiological, clinical, laboratory and radiological features of patients with non operative SD observed between 1990 and 2001 in our department of the "D. Cotugno" hospital - Naples. RESULTS: Eighteen patients with diagnosis of SD were evaluated. Etiologic agent was identified in 17 patients: M. tuberculosis in 5, brucella spp. in 4 and pyogenic bacteria in 8. Ten patients had underlying diseases or risk factors (4 diabetes mellitus, 3 arthrosis, 1 CRF, 1 IVDA and 2 previous back trauma). Symptoms preceded observation between 2 days and 12 months (median value 15 days). Seventeen patients presented fever, 13 back pain, 6 meningitis, 3 were comatous and 2 had severe sepsis. Ten patients showed high white blood cells count with granulocyte prevalence. Eritrosedimentation rate or C reactive protein were elevated in all patients. Diagnosis was confirmed in 8 patients only with radiographs of the spine, while 3 needed a CT and 11 a RMN imaging. Antimicrobial therapy was perfomed for at least 6 months in patients with brucellosis, 12 months in patients with tuberculosis and 2 months in patients with pyogenic SD. Persistent neurological deficit were observed in 2 patients. CONCLUSIONS: Neurological deficit may be avoid in patients affected by SD only with a carefull diagnosis and an accurate antibiotic therapy.