KALA-AZAR IN A ONE-YEAR-OLD SWEDISH CHILD - DIAGNOSTIC DIFFICULTIES BECAUSE OF ACTIVE HEMOPHAGOCYTOSIS

A one-year-old Swedish boy developed kala-azar six months after a holi day in Spain. Upon visiting the hospital after one week of illness he demonstrated clinical and laboratory findings of fever, splenomegaly a nd cytopenia. A fine-needle aspiration biopsy of the spleen revealed h emophagocytosis and he had increased serum levels of the cytokines tum or necrosis factor-alpha and interferon-gamma. Initially, a diagnosis of hemophagocytic lymphohistiocytosis was made. Re-evaluation of the s pleen smears and of the bone marrow aspiration revealed Leishmania par asites and subsequent therapy with sodium stibogluconate was successfu l. This patient illustrates the interesting similarities between these two disorders involving the mononuclear phagocyte system as well as t he problems involved in differential diagnosis. This case also reminds us of the possibility of contracting visceral leishmaniasis in Medite rranean countries.