Polyclonal hypergammaglobulinemia and high smooth-muscle autoantibody titers with specificity against filamentous actin: consider visceral leishmaniasis, not just autoimmune hepatitis.

摘要: Visceral leishmaniasis (VL) remains a public health problem in most countries bordering the Mediterranean basin. Its diagnosis is challenging and often delayed, as main clinical picture indistinguishable from that of other infectious non-infectious diseases. Herein, we report two unusual cases VL presented with several characteristics autoimmune hepatitis (AIH). Neither patient had history fever, only generalized symptoms accompanied by polyclonal hypergammaglobulinemia, cytopenias, signs portal hypertension, elevated transaminases, high titers antinuclear smooth-muscle autoantibodies (SMA) reactivity against filamentous actin (F-actin), which has been recognized specific to AIH. A AIH was considered, but bone marrow biopsy performed before liver exclude primary disease. The led VL. further confirmed IgG antibodies Leishmania spp. using ELISA PCR-based assays. Treatment amphotericin first case pentamidine second (because severe reaction amphotericin) effective. From point view, it should be emphasized that, anti-F-actin AIH-specific SMA possibility cautiously differentiated VL; this distinction paramount importance because initiation immunosuppression for treatment would detrimental underlying leishmaniasis. Therefore, such areas where disease still present, seems rational starting any immunosuppressive therapy.