Leishmaniasis mimicking collagen disease

Visceral leishmaniasis triggering an adult-onset Still's disease: a unique case

Adult‐onset Still's disease (AOSD) due to visceral leishmaniasis (VL) has not been previously reported. This case report analyzes a single episode of AOSD probably due to a visceral leishmaniasis successfully treated with pentamidine isethionate and prednisone.

Serum markers of rheumatoid arthritis in visceral leishmaniasis: rheumatoid factor and anti-cyclic citrullinated peptide antibody

Rheumatoid factor (RF) has been described in visceral leishmaniasis (VL). However, there is no report of RF-isotype or other rheumatoid arthritis (RA) autoantibody in VL. This work investigated RF and anti-cyclic citrullinated peptide antibody (CCP-Ab) in sera from 35 inhabitants from a VL area: 15 from healthy persons (HIEA); 10 from VL patients (VL), and 10 from subjects cured of VL (CVL). The controls were represented by sera from 15 healthy individuals (HI) and from 10 RA patients from a VL free area. IgM-RF was investigated by immunoturbidimetry, while IgA-RF and CCP-Ab by enzyme-linked immunosorbent assay (ELISA). Increased RF-IgM production was found in 9 out of 10 sera from both VL and RA groups (median level 100 and 182IU/ml respectively); in three out of CVL-sera (level 94IU), and in only one HIEA-serum (level 58IU). IgA-RF was only detected in RA-sera (5/10, 50%), while CCP-Ab was found in three VL and in four RA sera (median level 36.5U and 161.5U respectively). A strong correlation was observed between RF-IgM and VL in endemic area (P<0.0001). We concluded that an increased IgM-RF production associated with sporadic and moderate CCP-Ab synthesis is an autoimmune characteristic of VL.

Mixed cryoglobulinemia secondary to visceral Leishmaniasis

We describe a case of type II mixed cryoglobulinemia, with monoclonal IgMkappa rheumatoid factor, associated with visceral leishmaniasis caused by Leishmania infantum. Involvement of Leishmania antigen(s) in the formation of cryoprecipitable immune complexes was suggested by the fact that cryoglobulinemic vasculitis subsided after antiparasite therapy and that anti-Leishmania antibodies, as well as rheumatoid factor, were enriched in the cryoprecipitate. We observed 2 additional patients with visceral leishmaniasis and cryoglobulinemic vasculitis. All 3 patients had seemingly contracted leishmaniasis in Italy, were hepatitis C virus negative, and were initially diagnosed as having autoimmune disorders. These findings indicate that Leishmania can be an etiologic agent of type II mixed cryoglobulinemia. This parasitosis should be taken into consideration in the differential diagnosis of vasculitides in endemic areas.