LEISHMANIOSE VISCERAL AMERICANA - Considerações clínicas, hematológicas e anatomopatológicas a propósito de um caso

Abstract

The A.A. report one case of visceral leishmaniasis infected in Jacobina, State
of Bahia. The patient, a young male, 15 years old, was sick during two years,
having daily fever, hepato-splenomegaly, anemia, loss of weigh and strenght.
l"p to bis admission to the "Hospital das Clínicas" the patient had been
"rongly treated as a case of malaria infection. He was admitted to the Hospital
in very bad condition, showing besides the mentioned symptoms, a picture of
congestive heart failure which was removed after cardiotonic treatment. The diagnosis of visceral leishmaniasis was established during life by sternal marrow
puncture. Death occurred fourteen days after bis admission, following profuse and unchecked hemorrhages of the oral cavity. A few days before death, a necrotic lesion appeared in the mucous membrane of the patient's mouth and minute purpuric ~kin manifestations. In the first part of the paper the A.A. discuss the differential diagnosis of Yisceral leishmaniasis chiefly with malaria, schistosomiasis mansoni and American trypanosomiasis (Chagas' disease) but considerations on severa! other conditions which simulates kala-azar, were made. In the second part of the paper the A.A. comment on the hematological aspects of the case. The blood picture presented by this patient was characterized by intense anemia, marked leukopenia with granulocytopenia
and thrombocytopenia, namely a severe pancytopenia. The cytological study of the bone marrow (myelogram) revealed total aplasia of the marrow which the A.A. interpreted as responsible for the pancytopenia. Besides the mycloid tissue atrophy, extensive to the granulo-eritro-thi:ombocytopoiese, was verified histologically also evident generalized hyperplasia of the reticulo
enlothelial cells in the bone-marrow, spleen, liver and lymph-nodes examination.
The A.A. briefly reviewed the literature on the blood changes found in
kala-azar and gave opinion concerning the interpretation of such findings concluding that, in their patient, observed during the advanced stage of Leishmania donorani infection, the pancytopenia resulted from the hyperplasia of the reticuloendothelial system and lack of blood formation cells.

On the other hand, they believe that the hypersplenism admitted by some
observers as the cause of the inhibition of maturation of marrow cells was not
considered the fundamental process of pancytopenia in their patient.
Finally the A.A. report the post mortem examination and make somP. considerations on the pathological aspects of the víscera! leishmaniasis, describing the lesions found in their patient. They emphasize again the hiperplasia of the reticuloendothelial cells and cal! attention to the scarcity of the L. donovani bodies in some organs and to the richness in others (hone-marrow).