MONOCLONAL COMPONENT IN VISCERAL LEISHMANIASIS - A RARE ASSOCIATION THAT CAN LEAD TO MISDIAGNOSIS

The detection of monoclonal components is exceptional in patients with Visceral leishmaniasis (VL). The cases are here reported of two patie nts with VL in a non-endemic area and monoclonal components which pose d problems for the differential diagnosis with other entities associat ed with the presence of paraproteins. The predominant clinical manifes tations in both cases were general symptoms, fever and severe spleen e nlargement. One patient had a monoclonal triple band in urine and the other several oligoclonal bands in serum. In the initial bone marrow a spiration smear no parasites were observed in any of the two cases but a remarkable plasmacytosis in one of them. The presence of increased serum titers of anti-leishmania antibodies was the first demonstrative finding of VL. The diagnosis was confirmed with positive culture of L eishmania and therapy with pentavalent antimonials was successful in b oth cases. The different diagnostic possibilities are discussed and th e possibility of VL is emphasized even in non-endemic areas when monoc lonal components in serum or urine specimens are found and consistent clinical findings are present.