RESUMO
OBJECTIVE: To study the role of liver fine needle aspiration (FNA) in the diagnosis of kala-azar with an atypical presentation. STUDY DESIGN: The study group consisted of 23 patients (aged 18-37). All were admitted to Shiraz University Hospitals for the investigation of fever of unknown origin. The immunofluorescent antibody titer for kala-azar was positive (> 1:256 dilution). However, routine abdominal sonography revealed multiple small, hypoechoic lesions in the liver, more suggestive of metastatic tumor or miliary tuberculosis. The lesions were aspirated for cytologic diagnosis. RESULTS: The smears revealed many atypical hepatocytes, groups of epithelioid histiocytes and, in 15 patients, macrophages containing few to many Leishman bodies, allowing a diagnosis of kala-azar. The liver needle biopsy specimens confirmed the cytologic diagnosis of kala-azar and liver cell atypia. The patients were given glucantime therapy, and 21 recovered; 1 patient was lost to follow-up, and 1 died during treatment. CONCLUSION: Liver FNA is a useful procedure for the diagnosis of kala-azar, particularly in cases with atypical clinical presentations.
