1. Focal spleen lesions in visceral leishmaniasis, a neglected manifestation of a neglected disease: report of three cases and systematic review of literature.
- Author
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Rinaldi F, Giachè S, Spinicci M, Corsi P, Ambu S, Gianfaldoni G, Rigacci L, Arena U, Bartoloni A, and Zammarchi L
- Subjects
- Adult, Diagnosis, Differential, Humans, Italy, Leishmaniasis, Visceral diagnostic imaging, Male, Middle Aged, Neglected Diseases diagnostic imaging, Spleen diagnostic imaging, Splenic Diseases diagnostic imaging, Leishmaniasis, Visceral pathology, Neglected Diseases pathology, Spleen pathology, Splenic Diseases pathology
- Abstract
Background: The Mediterranean area is endemic for the zoonotic form of visceral leishmaniasis (VL) caused by Leishmania infantum, a species which has been recently associated with unexpected epidemiological and clinical features., Method: We report the result of a systematic review of the literature on VL unusually presenting with spleen focal lesions, including three previously unpublished cases., Results: A total of 28 cases of VL with multiple spleen focal lesions were retrieved. Twenty-six (93%) were acquired in the Mediterranean area, where L. infantum is endemic. Thirteen cases were diagnosed in children, and the remaining 15 cases in middle-aged adults, of whom 9 were immunosuppressed. Four patients (14%) underwent diagnostic splenectomy, while the diagnosis was confirmed by less invasive techniques in the remaining patients. The most common radiological patterns were: multiple subcentimetric or centimetric spleen lesions (size ≤ 1 cm in 14 of 19 cases, 74%), hypoechoic at ultrasonography (25 of 26 cases, 99%) and hypodense at CT scan (9 of 10 cases, 90%). PET-CT (available for four patients) showed an intense FDG spleen uptake. MRI and contrast-enhanced ultrasonography, available for two and one cases each, showed complex patterns., Conclusions: VL must be added to the list of possible differential diagnosis of spleen focal lesions and health care provider awareness about this condition will avoid unnecessary invasive diagnostic procedures.
- Published
- 2019
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