Nikolaos F. Giannakoulas, Enrique Speletas, vkaran Karanikas, Harold A. Damani 1
Abstract
Hepatosplenic T-cell lymphoma (HSTCL) is reported to exclusively be associated with immunodeficiency. Leishmaniasis is a parasitic infection that predominantly targets macrophages, with few reports in the literature of developed lymphoma in leishmaniasis. This case report unwinds a rare but possible case of HSTCL after leishmaniasis during the immunity recovery phase. We present the case of a 2-year-old girl who had been admitted to the ward with a history of prolonged fever and weight loss. There was splenomegaly during the physical examination period. She had been diagnosed with visceral leishmaniasis (kala-azar) and received liposomal amphotericin B and meglumine antimoniate consecutively. Three years later, she had pain in the left leg with massive splenomegaly. In December 2017, bone marrow assessment with biopsy and abdominal magnetic resonance imaging showed hepatosplenomegaly, splenic infarction, and moderately diffuse bone marrow involvement with hepatosplenic T-cell lymphoma. Alpha-fetoprotein was in the lower level of the normal range. On follow-up computed tomography, splenic enlargement and multiple lymphadenopathies developed. On 12th April 2018, eight weeks after chemotherapy (CYVE), HSTCL is exceptionally exclusive to immunodeficiency and is seen mostly with hepatosplenic T-cell lymphoma (HSTCL). However, a previously reported case with malignant transformation involving lymphatic T cells in leishmaniasis has been seen during immune reconstitution in the course of the hemophagocytic lymphohistiocytosis after the rare woman eruption. HSTCL is observed during immune restoration not only in T-cells but also in B and common natural killers. The development of HSTCL still shows that an oncogenic event is likely to develop during other severe T-cell or NK defects that are triggered by immune response against infectious microorganisms. A case of EBV-related HSTCL hyperplasia and complete immunophenotyping, radiologic staging, identifying and tracking EBV in our case is the distinction of our case.
Keywords: HSTCL; Visceral leishmaniasis; Chemotherapy; Lymphadenopathy
Copyright © 2019 by The American Society for BioMedicine and BM-Publisher, Inc.
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