• 1.

    World Health Organization, 2020. Leishmaniasis Fact Sheet WHO 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/leishmaniasis. Accessed June 1, 2020.

    • Search Google Scholar
    • Export Citation
  • 2.

    Pintado V, Martín-Rabadán P, Rivera ML, Moreno S, Bouza E, 2001. Visceral leishmaniasis in human immunodeficiency virus (HIV)-infected and non-HIV-infected patients. Medicine (Baltimore) 80: 5473.

    • Search Google Scholar
    • Export Citation
  • 3.

    World Health Organization, 2020. Global Health Observatory Data Repository - Visceral Leishmaniasis. Available at: https://www.who.int/gho/neglected_diseases/leishmaniasis/en/. Accessed June 1, 2020.

    • Search Google Scholar
    • Export Citation
  • 4.

    Hossain F, Ghosh P, Khan MAA, Duthie MS, Vallur AC, Picone A, Howard RF, Reed SG, Mondal D, 2017. Real-time PCR in detection and quantitation of Leishmania donovani for the diagnosis of visceral leishmaniasis patients and the monitoring of their response to treatment. PLoS One 12: e0185606.

    • Search Google Scholar
    • Export Citation
  • 5.

    Rinaldi F, Giachè S, Spinicci M, Corsi P, Ambu S, Gianfaldoni G, Rigacci L, Arena U, Bartoloni A, Zammarchi L, 2019. Focal spleen lesions in visceral leishmaniasis, a neglected manifestation of a neglected disease: report of three cases and systematic review of literature. Infection 47: 507518.

    • Search Google Scholar
    • Export Citation
  • 6.

    Bükte Y, Nazaroglu H, Mete A, Yilmaz F, 2004. Visceral leishmaniasis with multiple nodular lesions of the liver and spleen: CT and sonographic findings. Abdom Imaging 29: 8284.

    • Search Google Scholar
    • Export Citation
  • 7.

    Zanoni L 2019. 18F-FDG PET/CT in visceral leishmaniasis: uptake patterns in the context of a multiannual outbreak in northern Italy. Ann Nucl Med 33: 716723.

    • Search Google Scholar
    • Export Citation
  • 8.

    Martin C, Castaigne C, Tondeur M, Flamen P, De Wit S, 2013. Role and interpretation of fluorodeoxyglucose-positron emission tomography/computed tomography in HIV-infected patients with fever of unknown origin: a prospective study. HIV Med 14: 455462.

    • Search Google Scholar
    • Export Citation
  • 9.

    Ravaglia C, Gurioli C, Casoni GL, Asioli S, Poletti V, 2013. Fever, splenomegaly and lymphopenia in sarcoidosis. Thorax 68: 496497.

  • 10.

    Eichenberger A, Buechi AE, Neumayr A, Hatz C, Rauch A, Huguenot M, Diamantis-Karamitopoulou E, Staehelin C, 2017. A severe case of visceral leishmaniasis and liposomal amphotericin B treatment failure in an immunosuppressed patient 15 years after exposure. BMC Infect Dis 17: 81.

    • Search Google Scholar
    • Export Citation
  • 11.

    Mao G, Yang G, Cheng Y, Zee CS, Huang W, Ni W, Meng G, Chen Z, 2014. Multiple nodular lesions in spleen associated with visceral leishmaniasis. Medicine (Baltimore) 93: e272.

    • Search Google Scholar
    • Export Citation
  • 12.

    Evers G, Pohlen M, Berdel WE, Thoennissen NH, Titze U, Köhler G, Weckesser M, Anthoni C, Mesters RM, 2014. Visceral leishmaniasis clinically mimicking lymphoma. Ann Hematol 93: 885887.

    • Search Google Scholar
    • Export Citation
  • 13.

    Berry CE, Tsai J, Tierney A, Pickles R, 2013. Visceral leishmaniasis in a patient taking adalimumab for rheumatoid arthritis. Med J Aust 198: 331333.

    • Search Google Scholar
    • Export Citation
  • 14.

    van Raalte DH, Wesselius HM, de Klerk G, 2014. Unexpected diagnosis of visceral leishmaniasis in a patient presenting with an infected ICD lead. Neth J Med 72: 146148.

    • Search Google Scholar
    • Export Citation
  • 15.

    Gallina V, Binazzi R, Golemi A, Farsad M, Weiss G, Wiedermann CJ, 2014. Imported visceral leishmaniasis–unexpected bone marrow diagnosis in a patient with fever, pancytopenia, and splenomegaly. Am J Blood Res 4: 101105.

    • Search Google Scholar
    • Export Citation
  • 16.

    Machelart I, Lapoirie J, Viallard J-F, Mirabel M, Lazaro E, Greib C, Rivière E, 2019. Visceral leishmaniasis with hemophagocytic lymphohistiocytosis in an immunocompetent adult. Méd Mal Infec 49: 548550.

    • Search Google Scholar
    • Export Citation
  • 17.

    CDC, 2004. Two cases of visceral leishmaniasis in U.S. military personnel–Afghanistan, 2002–2004. MMWR Morb Mortal Wkly Rep 53: 265268.

    • Search Google Scholar
    • Export Citation
  • 18.

    Schwetz V 2018. Visceral leishmaniasis in a patient with diabetes mellitus type 2 and discrete bicytopenia. Clin Case Rep 6: 7881.

  • 19.

    Yapar AF, Reyhan M, Kocer NE, Aydin M, Nursal GN, 2011. Diffuse splenic F-18 FDG uptake in visceral leishmaniasis. Clin Nucl Med 36: 10411043.

  • 20.

    Chianura L, De Ferrari ME, Popescu CE, Cantoni S, Colussi G, Rossetti C, Puoti M, 2014. The role of F-18 FDG PET in the diagnosis of visceral leishmaniasis: two case reports. J Case Rep 4: 2025.

    • Search Google Scholar
    • Export Citation
  • 21.

    Tatarelli P 2018. Visceral leishmaniasis in hematopoietic cell transplantation: case report and review of the literature. J Infect Chemother 24: 990994.

    • Search Google Scholar
    • Export Citation
  • 22.

    Sayin Kutlu S, Kutlu M, Herek D, Dirim Erdogan D, Ozdemir K, Sen Turk N, Yaylali O, Hacıoglu S, Turgut H, 2019. Multiple nodular lesions in spleen and liver in visceral leishmaniasis. Infect Dis Clin Microbiol 1: 7077.

    • Search Google Scholar
    • Export Citation
  • 23.

    Martinez de Narvajas I 2019. Acute liver failure due to visceral leishmaniasis in Barcelona: a case report. BMC Infect Dis 19: 874.

  • 24.

    Kyrtatos PG, Debard A, Martin-Blondel G, Alvarez M, Delobel P, Marchou B, Massip P, Wagner T, 2013. FDG-PET/CT findings during immune reconstitution in an HIV-1 patient infected with visceral leishmaniasis. Infection 41: 10171019.

    • Search Google Scholar
    • Export Citation
  • 25.

    Casadevall M, Mambré L, Cornet M, Caillat-Vigneron N, Le Jeunne C, Aslangul E, 2010. Apport de la tomographie par émission de positons couplée au scanner dans le diagnostic de leishmaniose viscérale. Méd Mal Infect 40: 719721.

    • Search Google Scholar
    • Export Citation
  • 26.

    Gibson GM, Arnold C, Kumar ASR, 2014. 18F-FDG uptake in multiple splenic foci on PET/CT. Clin Nucl Med 39: 828830.

  • 27.

    Lupi A, Todeschini G, Zanco P, 2006. Diffuse metabolic activation of reticuloendothelium on F-18 FDG PET imaging in a case of visceral Leishmania. Clin Nucl Med 31: 3436.

    • Search Google Scholar
    • Export Citation
  • 28.

    Fuertes J, Garcia-Bennett J-R, Iftimie S, Danús M, Abreu , 2014. Focal splenic FDG uptake in a patient with Kala-azar (visceral leishmaniasis). Clin Nucl Med 39: 387390.

    • Search Google Scholar
    • Export Citation
  • 29.

    Prajapati R, Kumar A, Sharma P, Singla V, Bansal N, Dhawan S, Arora A, 2016. A rare presentation of leishmaniasis. J Clin Exp Hepatol 6: 146148.

  • 30.

    Vase , Hellberg YK, Larsen CS, Petersen E, Schaumburg H, Bendix K, Ravel C, Bastien P, Christensen M, D’Amore F, 2012. Development of splenic marginal zone lymphoma in a HIV-negative patient with visceral leishmaniasis. Acta Haematol 128: 2022.

    • Search Google Scholar
    • Export Citation
  • 31.

    Zhang G, Zhong J, Wang T, Zhong L, 2020. A case of visceral leishmaniasis found by left oblique hernia: a case report. Exp Ther Med 2020: 26972701.

    • Search Google Scholar
    • Export Citation
  • 32.

    Zaidi H, Karakatsanis N, 2018. Towards enhanced PET quantification in clinical oncology. Br J Radiol 91: 20170508.

  • 33.

    Kouijzer IJE, Mulders-Manders CM, Bleeker-Rovers CP, Oyen WJG, 2018. Fever of unknown origin: the value of FDG-PET/CT. Semin Nucl Med 48: 100107.

    • Search Google Scholar
    • Export Citation
  • 34.

    Kobayashi K, Smith D, 2012. Image-guided biopsy: what the interventional radiologist needs to know about PET/CT 1. RadioGraphics 32: 14831501.

    • Search Google Scholar
    • Export Citation
  • 35.

    Metser U, Even-Sapir E, 2006. The role of 18F-FDG PET/CT in the evaluation of solid splenic masses. Semin Ultrasound CT MRI 27: 420425.

  • 36.

    Albano D, Giubbini R, Bertagna F, 2018. 18F-FDG PET/CT in splenic marginal zone lymphoma. Abdom Radiol 43: 27212727.

  • 37.

    Rezaee A, Zhao XF, Dilsizian V, Chen W, 2014. Pediatric presentation of splenic marginal zone lymphoma on FDG PET/CT scan. Clin Nucl Med 39: 178180.

    • Search Google Scholar
    • Export Citation
  • 38.

    Molina I 2013. Ultrasensitive real-time PCR for the clinical management of visceral leishmaniasis in HIV-infected patients. Am J Trop Med Hyg 89: 105110.

    • Search Google Scholar
    • Export Citation

 

 

 

 

Utility of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Visceral Leishmaniasis: Case Report and Literature Review

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  • 1 Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain;
  • 2 Grupo de Estudios de Infecciones por Micobacterias (GEIM), SEIMC, Madrid, Spain;
  • 3 Department of Nuclear Medicine, Vall d’Hebron University Hospital, Barcelona, Spain

ABSTRACT

The diagnosis of visceral leishmaniasis (VL) is complicated and often unsuspected. Little is known of the usefulness of nuclear imaging in VL. Our objective was to describe findings seen in fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in cases of VL. We retrospectively reviewed VL cases diagnosed at Vall d’Hebron University Hospital from May 2012 to May 2018 and selected those that had an FDG-PET/CT performed. Information on procedures and details of the FDG-PET/CT features and follow-up were collected. We then systematically reviewed the literature on VL and FDG-PET/CT. Four of 43 patients diagnosed with VL had an FDG-PET/CT performed. All four patients presented diffuse splenic uptake of FDG-PET/CT. Adenopathy was not always present, and bone marrow uptake was found in two patients. A posttreatment FDG-PET/CT in one patient revealed normalization of initial findings. In the literature review, 43 of 50 cases presented similar splenic uptake in the PET/CT, being described as different patterns: “increased metabolism,” “homogeneous,” “diffuse,” “diffuse and multifocal,” “nodular,” “patchy and granular,” “subcortical,” and “compatible with lymphoma.” Other frequent findings were bone marrow uptake and adenopathies. We, therefore, conclude that FDG-PET/CT could become a useful tool for the diagnosis and follow-up of VL and that VL should be taken into account in patients with fever of unknown origin with enhanced splenic uptake in FDG-PET/CT. Differential diagnosis in these cases should be made with splenic primary lymphoma, virus infections, chemotherapy, and colony-stimulating factor therapy. Further structured studies with more cases are needed to define its diagnostic and prognostic value.

Author Notes

Address correspondence to Adrián Sánchez-Montalvá, Departamento de Enfermedades Infecciosas, Hospital Universitario Vall d’Hebron, Passeig Vall d’Hebron, 119-129, Edificio General, 6a planta, Barcelona 08035, Spain. E-mails: adsanche@vhebron.net or adrian.sanchez.montalva@gmail.com

Disclosure: A. S.-M. is supported by a postdoctoral grant “Juan Rodés” (JE18/00022) from Instituto de Salud Carlos III through the Ministry of Economy and Competitiveness, Spain.

Authors’ addresses: Harriet P. Pinnegar, Adrián Sánchez-Montalvá, Pau Bosch-Nicolau, Fernando Salvador, and Israel Molina, Department of Infectious diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain, E-mails: harrietphyllispinnegar@gmail.com, adsanche@vhebron.net, pau.boschnicolau@gmail.com, medinano@yahoo.es, and israelmolina@ymail.com. Marta Barios Profitos, Department of Nuclear Medicine, Vall d’Hebron University Hospital, Barcelona, Spain, E-mail: mbarios@vhebron.net.

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