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Images in Clinical Hematology
DOI: 10.1016/j.htct.2018.06.003
Open Access
Visceral leishmaniasis: amastigotes in the bone marrow
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Thiago Rodrigo de Noronha, Ricardo Ambrósio Fock
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hemato@usp.br

Corresponding author. Clinical Laboratory Division, Pharmacy and Clinical Laboratory Department, University Hospital, University of São Paulo. Av. Lineu Prestes, 2565. São Paulo, SP, Brazil. CEP: 05508-900. Tel.: +55 11 3091 3639..
Hospital Universitário da Universidade de São Paulo (HU USP), São Paulo, SP, Brazil
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Received 12 December 2017, Accepted 20 June 2018
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A 50-year-old man came to the emergency room of a university hospital complaining of weight loss, fever and abdominal pain associated with hepatosplenomegaly. Laboratory investigations revealed pancytopenia with red blood cell (RBC) count of 2.35×1012/L, hemoglobin 7.2g/dL (RBCs with rouleaux formation), platelets of 75.7×109/L, white blood cell count of 2.77×109/L (with 58% neutrophils, 27% lymphocytes, 15% monocytes, 0% eosinophils and 0% basophils), hypoalbuminemia (1.31g/dL) and hypergammaglobulinemia (6.63g/dL). Serological test results were negative for antibodies for hepatitis (B and C) and human immunodeficiency virus (HIV). Due to the laboratory findings and sustained pancytopenia, a bone marrow biopsy was performed which showed Leishmania amastigotes phagocytosed by macrophages (Figure 1) confirming the diagnosis of visceral leishmaniasis infection.1,2

Figure 1.
(0.25MB).

Leishmania amastigotes phagocytosed by macrophages. Black arrows show amastigotes (May-Grünwald stain; (A) magnification: 400×, (B) magnification: 1000×).

References
[1]
P. Pagliano, S. Esposito
Visceral leishmaosis in immunocompromised host: an update and literature review
J Chemother, 29 (2017), pp. 261-266 http://dx.doi.org/10.1080/1120009X.2017.1323150
[2]
K.L. Koster, H.J. Laws, A. Troeger, R. Meisel, A. Borkhardt, P.T. Oommen
Visceral leishmaniasis as a possible reason for pancytopenia
Front Pediatr, 29 (2015), pp. 59
Copyright © 2018. Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular
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Hematology, Transfusion and Cell Therapy

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