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Year : 2017  |  Volume : 60  |  Issue : 3  |  Page : 433-434
Fine-needle aspiration cytology of leishmanial lymphadenitis in a HIV reactive patient


Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India

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Date of Web Publication22-Sep-2017
 

How to cite this article:
Biswas B, Pal S. Fine-needle aspiration cytology of leishmanial lymphadenitis in a HIV reactive patient. Indian J Pathol Microbiol 2017;60:433-4

How to cite this URL:
Biswas B, Pal S. Fine-needle aspiration cytology of leishmanial lymphadenitis in a HIV reactive patient. Indian J Pathol Microbiol [serial online] 2017 [cited 2019 Dec 7];60:433-4. Available from: http://www.ijpmonline.org/text.asp?2017/60/3/433/215394


Leishmaniasis is a parasitic disease caused by protozoa called “Leishmania species” and it is transmitted by “Sandfly.[1]” It is an endemic disease in several parts of India.[2] Leishmaniasis is categorized under several manifestations – visceral, cutaneous, and mucosal.[1] The parasite affects the macrophages of mononuclear phagocyte system and increased incidence seen in malnutrition, immunosuppression, and HIV infection.[1],[2] Leishmaniasis is an emerging opportunistic coinfection in HIV-positive patients in endemic areas.[3] Diagnosis of the cases often delayed due to lack of awareness and uncommon presentation.[3] Demonstration of Leishman–Donovan (LD) bodies in lymph node by fine-needle aspiration cytology (FNAC) has rarely been reported in visceral leishmaniasis.[4] We describe a rare case of cytology of leishmanial lymphadenitis involving epitrochlear lymph node in a case of HIV reactive visceral leishmaniasis.

A 38-year-old male patient presented with a history of low-grade fever, weight loss, and anorexia for the past 6 weeks. General examination revealed mild pallor, splenomegaly, and mild hepatomegaly with discrete enlarged lymph nodes at the right epitrochlear area and right cervical region. Biochemical parameters were within normal limit except mild elevation of liver enzymes (serum glutamic pyruvic transaminase – 60 IU/L, serum glutamic oxaloacetic transaminase – 53 IU/L, and lactic dehydrogenase – 370 IU/L). Hematological examinations revealed hemoglobin level of 10.2 g% and elevated erythrocyte sedimentation rate (ESR) (ESR – 68 mm/h). On serological screening, he was reactive to HIV I.

On FNAC of epitrochlear lymph node, the smears showed polymorphous cell population, comprised reactive lymphoid cells, histiocytes, isolated epithelioid cells, many tangible body macrophages, and macrophages filled with leishmania amastigote form [Figure 1] and [Figure 2]a, [Figure 2]b. On subsequent bone marrow examination, the smears revealed high parasitic load of amastigote form of leishmania in bone marrow smears (parasite load – [5+]). The diagnosis was established as visceral leishmaniasis with leishmania lymphadenitis with HIV reactive status. He was treated with stibogluconate for 28 days with antiretroviral therapy.
Figure 1: Cytology of lymph node shows polymorphous population of lymphoid cells, isolated epithelioid cells, and plenty of extracellular and intracellular Leishman–Donovan bodies (Leishman and Giemsa, ×40)

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Figure 2: (a) Cytology of the lymph node reveals intracellular and extracellular Leishman–Donovan bodies and macrophages (Leishman and Giemsa, high-power view). (b) Cytology reveals intracellular Leishman–Donovan body inside the macrophages (Leishman and Giemsa, oil immersion view)

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Generalized lymphadenopathy is an important presenting feature of HIV infection, and lymphadenopathy is also not uncommon in leishmaniasis. Most often, the lymphadenopathy is due to the disease itself, but secondary causes such as tuberculosis, fungal infections, and lymphoma are also common.[3],[4],[5] Microscopically, most of the leishmanial lymphadenopathy did not produce LD bodies. They exhibit reactive lymphoid hyperplasia or granulomatous reaction which can be misinterpreted as tuberculous origin. The presence of LD bodies in aspirate is pathognomonic of leishmanial lymphadenitis, may or may not be associated with visceral leishmaniasis and postkala-azar dermal leishmaniasis.[4] Microscopically, LD bodies are small round/ovoid structures of 2–5 μm (diameter) with fine membrane and central round nucleus and rod-shaped kinetoplast.[3] In FNAC smears, there will be intracellular and extracellular LD bodies with nonnecrotic granulomatous reaction, histiocytes, plasma cells, and giant cells formation.[4]

Although leishmaniasis is a rare cause of lymphadenopathy, it should be considered as a differential diagnosis, particularly in endemic region. Visceral leishmaniasis may be a secondary cause of lymphadenopathy and pyrexia of unknown origin in HIV patients. Cytology diagnosis is an excellent tool for the management of leishmanial lymphadenitis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Beljan R, Sundov D, Luksic B, Soljic V, Burazer MP. Diagnosis of visceral leishmaniasis by fine needle aspiration cytology of an isolated cervical lymph node: Case report. Coll Antropol 2010;34:237-9.  Back to cited text no. 1
    
2.
Reus M, García B, Vázquez V, Morales D, Fuster M, Sola J. Visceral leishmaniasis: Diagnosis by ultrasound-guided fine needle aspiration of an axillary node. Br J Radiol 2005;78:158-60.  Back to cited text no. 2
    
3.
Bode AN, Poflee SV, Pande NP, Umap PS. Leishmaniasis in a patient with HIV co-infection: Diagnosis on fine needle aspiration cytology. Indian J Pathol Microbiol 2015;58:563-5.  Back to cited text no. 3
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4.
Sah SP, Prasad R, Raj GA. Fine needle aspiration of lymphadenopathy in visceral leishmaniasis. Acta Cytol 2005;49:286-90.  Back to cited text no. 4
    
5.
Fine needle aspiration of a lymph node in an HIV patient with chronic infection by Leishmania: A case report. de Faria FB, Barroca H. Fine needle aspiration of a lymph node in an HIV patient with chronic infection by Leishmania: A case report. Acta Cytol 2010;54 5 Suppl:946-8.  Back to cited text no. 5
    

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Correspondence Address:
Subrata Pal
Kalpataru Apartment, Sahid Colony, BT Road, PS-Khardaha, North 24 Pargana, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_626_16

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