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Distinguishing Visceral Leishmaniasis from Intolerance to Pegylated Interferon-α in a Thalassemic Splenectomized Patient Treated for Chronic Hepatitis C

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  • 1 ‘D. Cotugno’ Hospital, Department of Emergency, 1st Division of Infectious Diseases, Naples, Italy; ‘A. Cardarelli’ Hospital, Hematology Unit, Naples, Italy; Istituto Superiore di Sanità, Department of Infectious, Parasitic and Immunomediated Diseases, Rome, Italy
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A 37-year-old splenectomized man affected by β-thalassemia and chronic hepatitis, recently treated with pegylated interferon-α (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.

Author Notes

Reprint requests: Pasquale Pagliano, c/o Ospedale D. Cotugno, I Divisione, Via G. Quagliariello 54, 80131 Naples, Italy, E-mail: ppagliano@libero.it.
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