Haematologica 2002; 87:(08)EIM21
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Peripheral intramonocytic and intraneutrophil leishmanias observed in a chronic myelomonocytic leukemia patient
Marcello Fiorini, Maria Francesca Messina, Alberto Barracchia.
Laboratorio di Analisi Chimico-Cliniche e Microbiologiche &endash; Ospedale di Portoferraio. Azienda USL n. 6 Livorno, zona dell'Elba. Italy
Correspondence: Dr. Marcello Fiorini, Laboratorio di Analisi Chimico-Cliniche e Microbiologiche &endash; Ospedale di Portoferraio. Loc. S. Rocco 57037 Portoferraio (LI) Italy. Phone: +(39)565-926644. Fax. +(39)565-926615. E-mail: fiorinim@virgilio.it or laboratorio.elba@sud.usl6.toscana.it.

We report the case of unexpectedly observed leishmaniasis1 in a 79- year old Italian man affected by chronic myelomonocytic leukemia, who was admitted to the Hospital of Portoferraio (Isle of Elba - Italy) because of fatigue, anemia with monocytic leukocytosis, hepatomegaly and splenic enlargement. The Isle of Elba is an endemic canine leishmaniasis.2 A complete blood count revealed the following: hemoglobin, 8.6 g/dL; RBC, 3.25x106/mL; hematocrit, 29%; MCV, 90 mm3; WBC, 16,310/mL with a differential cont of 55.0% neutrophils, 14.5% lymphocytes, 26.0% monocytes, and 4.0% myelocytes, platelets 110,000/mL; RDW 21.9. Reticolocyte count was 10%. Bone marrow smear analysis showed myeloid hyperplasia with an elevated level of monocytes and dysplastic myelocytes, 9% blasts. Monolobate dysplastic megakaryocytes were found. In a few days, the WBC count became WBC 4,600/mL, hemoglobin 7.4 g/dL and PLT 7,000/mL, and the peripheral blood smear revealed both intramonocytic and intraneutrophilic Leishmania amastigotes. Death occurred the same day proceeded by uncontrolled hemorrhage. Laboratory tests showed the presence of antileishmania antibody 1:320. The peripheral blood smear showed not only intramonocytic but especially intraneutrophil amastigotes in a CMMoL patient (Figures 1 and 2). In immunocompromised patients from endemic countries, in cases of fever, pancytopenia and hepato-splenomegaly, physicians should request careful microscopic examination of blood smears.

References

  1. Vidyashankar C., Agraval R. Leishmaniasis. eMedicine Journal 2001 December 1; 2 (n12). Available from URL: http://www.emedicine.com/ped/topic1292.htm
  2. Mancianti F., Gradoni L., Gramoccia M, Pieri S., Marconcini A. Canine Leishmaniasis in the Isle of Elba, Italy. Trop Med Parasitol 1986; 37:110-2.
  3. Barracchia A., Lari R., Giacomelli G., Pieri S. La leishmaniosi all'Isola d'Elba. Descrizione di un caso. Considerazione diagnostico-epidemiologiche. G Mal Infett Parassit 1989; 41:477-9.