Thread by @guerreroespejo

A 17-MO♀️, Morocco: fever, pallor, epistaxis, gingival petechiae, lower limbsedema, & hepatosplenomegaly.

Pancytopenia, hypoalbunemia.
Triglyceridemia, ferritinemia, LDH & fibrinogen:⬆️
PT⬇️
Direct Coombs test:➕

🔬myelogram: ?
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#parasitology #haematology #Pediatrics

Myelogram revealed the presence of leishmania bodies and figures of hemophagocytosis.

VISCERAL LEISHMANIASIS ASSOCIATED WITH MACROPHAGE ACTIVATION SYNDROME
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doi.org/10.1016/j.idcr…
#Pathologists #microbiology #IDtwitter

The patient was put on liposomal amphotericin B and corticosteroid therapy with good clinical and biological evolution.
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#MedTwitter #Doctor

The combination of visceral leishmaniasis (VL) and macrophage activation syndrome (MAS), with a poor prognosis, makes the diagnosis difficult due to their similar clinical presentation.
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#MedStudentTwitter #resident

The association of visceral leishmaniasis & macrophage activation syndrome:
✔️rare & should be evoked even in non-endemic areas
✔️late diagnosis worsens the prognosis& may even be responsible for the death of patients despite an aggressive treatment.
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#medicine #parasites

The usual clinical picture of visceral leishmaniasis is made up of the well-known triad: fever, pallor, and splenomegaly.
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#MedicalStudents #MedEd

Macrophage activation syndrome, also known as lymphohistiocytic hemophagocytosis, is a clinical biological entity caused by uncontrolled activation and proliferation of cells of the lymphohistiocytic lineage responsible for the destruction of multiple organs
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#pathology

None of the clinical symptoms or laboratory abnormalities are specific to MAS.

Therefore, it is the association of clinical and biological signs (Table) that is very evocative and that leads to a strong presumption
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#pathTwitter
doi.org/10.1016/j.idcr…

In addition, histological evidence of hemophagocytosis images is of great diagnostic value and remains the gold standard for MAS, although it is often absent at the very beginning

Fig.: Hemophagocytosis with intramacrophagic Leishmania bodies.

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#pathTwitter #pediatric