We report the occurrence of visceral leishmaniasis in three patients coming from the northern part of Italy treated with immunosuppressivedrugs for different rheumatic conditions. This paper highlights the importance of adequate work-up in those patients presenting with serious clinical manifestations that can complicate, exacerbateor mimic a systemic connectivetissue disorder.A prompt diagnosis is very important because visceral leishmaniasis has a high mortality and, if untreated, can be fatal.
Hellmann DB , Petri M , Whiting-O’Keefe Q.Fatal infections in systemic lupus erythematosus: the role of opportunistic organisms . Medicine (Baltimore)1987; 66: 341-348 .
2.
Badaro R , Carvalho EM , Rocha H , Queiroz AC , Jones TC.Leishmania donovani: an opportunistic microbe associated with progressive disease in three immunocompromised patients . Lancet1986; i: 647-648 .
3.
Wallis PJ , Clark CJ.Visceral leishmaniasis complicating systemic lupus erythematosus . Ann Rheum Dis1983; 42: 201-202 .
4.
Fernandez-Guerrero ML , Aguado JM , Buzon Cet al.Visceral leishmaniasis in immunocompromised hosts . Am J Med1987; 83: 1098-1102 .
5.
Granel B , Serratrice J , Swiader Let al.Crossing of antinuclear antibodies and anti-leishmania antibodies . Lupus2000; 9: 548-550 .
6.
Braun J , Sieper J , Schulte KL , Thiel E , Janitschke K.Visceral leishmaniasis mimicking a flare of systemic lupus erythematosus . Clin Rheumatol1991; 10: 445-448 .
7.
Hochberg MC.Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus . Arthritis Rheum1997; 40: 1725-1725 .
8.
Ossandon A , Bompane E , Marocchi Fet al.Febbre, splenomegalia, ipergammaglobulinemia: lupus eritematoso sistemico e leishmaniasi viscerale . Reumatismo2002; 54 (S2): 385-385 (abstract).
9.
Gardener-Medwin M , Powell R.One patient, two unusual conditionsand three basic lessons . Ann Rheum Dis1996; 55: 350-352 .
10.
Broelkaert-Van Orshoven A , Michielson P , Van Despitte J.Fatal leishmaniasis in renal transplant patient . Lancet1979; ii: 740-741 .
11.
Murray HW , Rubin BY , Rothermel CD.Killing of intracellular Leishmania donovani by lymphokine-stimulated human mononuclear phagocytes. Evidence that interferon-gamma is the activating lymphokine . J Clin Invest1983; 72: 1506-1510 .
12.
Galanakis E , Siamopoulou A , Lapatsanis PD.Leishmaniasis mimicking collagen disease . Lancet1997; 350: 368-369 .
