Leishmania colitis: An uncommon cause of gastrointestinal bleeding in an immunosuppressed patient

Vara-Luiz, Francisco; Pires, Helena; Mendes, Ivo; Palma, Carolina; Fernandes, Eduardo; Elisa Teles, Ana; Martins do Vale, Francisco; Patita, Marta; Fonseca, Jorge; Pinto-Marques, Pedro

doi:10.1016/j.gastrohep.2024.502254

array:22 ["pii" => "S0210570524002486" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2024.502254" "estado" => "S200" "fechaPublicacion" => "2024-10-15" "aid" => "502254" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:17 [ "pii" => "S0210570524002632" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2024.502264" "estado" => "S100" "fechaPublicacion" => "2024-10-18" "aid" => "502264" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "Carta científica" "titulo" => "Ictericia tras colangiopancreatografía retrógrada endoscópica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Sustained jaundice after endoscopic retrograde cholangiopancreatography" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 985 "Ancho" => 2438 "Tamanyo" => 140658 ] ] "descripcion" => array:1 [ "es" => "Evolución de los niveles de bilirrubina total (mg/dl) en el tiempo (días). Se observa la evolución de las cifras de bilirrubina desde el día 0 (día de realización de la colangiopancreatografía retrógrada endoscópica [CPRE]). Al añadir ácido ursodeoxicólico en el día +3 no se observan cambios significativos. Al añadir prednisona se observa un descenso progresivo de la bilirrubinemia, que se normaliza a partir del día +111." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Idoia Agulleiro Beraza, Eduardo Leo Carnerero, José Manuel Sousa Martín, Rose Marie Vallejo Vigo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Idoia" "apellidos" => "Agulleiro Beraza" ] 1 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Leo Carnerero" ] 2 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Sousa Martín" ] 3 => array:2 [ "nombre" => "Rose Marie" "apellidos" => "Vallejo Vigo" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570524002632?idApp=UINPBA00004N" "url" => "/02105705/unassign/S0210570524002632/v1_202410180434/es/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S0210570520302533" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2020.05.020" "estado" => "S200" "fechaPublicacion" => "2020-09-04" "aid" => "1593" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "ret" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:8 [ "idiomaDefecto" => true "titulo" => "WITHDRAWN: Higher appendicular skeletal muscle mass percentage is an independent protective factor for non-alcoholic steatohepatitis and significant fibrosis in male with NAFLD" "tienePdf" => "en" "tieneTextoCompleto" => 0 "tieneResumen" => "en" "contieneResumen" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Yilun Xu, Yaqi Guan, Wenyi Jin, Li Ding, Jinming Wu" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Yilun" "apellidos" => "Xu" ] 1 => array:2 [ "nombre" => "Yaqi" "apellidos" => "Guan" ] 2 => array:2 [ "nombre" => "Wenyi" "apellidos" => "Jin" ] 3 => array:2 [ "nombre" => "Li" "apellidos" => "Ding" ] 4 => array:2 [ "nombre" => "Jinming" "apellidos" => "Wu" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570520302533?idApp=UINPBA00004N" "url" => "/02105705/unassign/S0210570520302533/v2_202101310608/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Scientific letter" "titulo" => "Leishmania colitis: An uncommon cause of gastrointestinal bleeding in an immunosuppressed patient" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Francisco Vara-Luiz, Helena Pires, Ivo Mendes, Carolina Palma, Eduardo Fernandes, Ana Elisa Teles, Francisco Martins do Vale, Marta Patita, Jorge Fonseca, Pedro Pinto-Marques" "autores" => array:10 [ 0 => array:4 [ "nombre" => "Francisco" "apellidos" => "Vara-Luiz" "email" => array:1 [ 0 => "franciscovaraluiz@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Helena" "apellidos" => "Pires" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Ivo" "apellidos" => "Mendes" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Carolina" "apellidos" => "Palma" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Eduardo" "apellidos" => "Fernandes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "Ana" "apellidos" => "Elisa Teles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 6 => array:3 [ "nombre" => "Francisco" "apellidos" => "Martins do Vale" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 7 => array:3 [ "nombre" => "Marta" "apellidos" => "Patita" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "Jorge" "apellidos" => "Fonseca" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 9 => array:3 [ "nombre" => "Pedro" "apellidos" => "Pinto-Marques" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Aging Lab, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Almada, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Radiology Department, Hospital Garcia de Orta, Almada, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Pathology Department, Hospital Garcia de Orta, Almada, Portugal" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colitis por Leishmania: una causa rara de hemorragia digestiva en paciente inmunodeprimido" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2338 "Ancho" => 3292 "Tamanyo" => 1037726 ] ] "descripcion" => array:1 [ "en" => "(A) Computed tomography showing pronounced circumferential wall thickening of the recto-sigmoid junction, measuring up to 14mm. (B) Colonoscopy revealing multiple circumferential irregular shaped ulcers and erosions with surrounding erythema, covered by white exudates in the recto-sigmoid junction. (C) Eosinophilic infiltration in the lamina propria and architectural distortion with granuloma formation and multinucleated giant (hematoxylin-eosin staining). (D) Intrahistiocytic microorganisms compatible with Leishmania amastigotes (Giemsa staining)." ] ] ] "textoCompleto" => "A 67-year-old male with history of syndrome of remitting seronegative symmetrical synovitis with pitting edema taking prednisolone 20mg/day, was admitted with fever and arthralgia. During hospitalization, the patient developed abdominal pain and hematochezia with hemodynamic instability. Abdominopelvic CT showed pronounced circumferential wall thickening of the recto-sigmoid junction, measuring up to 14mm, without localized nodularity or mass effect (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The preservation of the stratified mural architecture, despite the thickening, suggested a potentially reversible inflammatory process. No significant lymphadenopathy or extraintestinal features were observed. Upper endoscopy showed no findings suggestive of upper gastrointestinal bleeding. Colonoscopy revealed loss of vascular markings, multiple circumferential irregular shaped ulcers and erosions with surrounding erythema, covered by white exudates, as well as loss of vascular markings and mucosal friability in the recto-sigmoid junction (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Biopsies presented an acute colitis with eosinophilic infiltration in the lamina propria and architectural distortion with formation of granuloma and multinucleated giant cells (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). On Giemsa staining, intrahistiocytic microorganisms compatible with Leishmania amastigotes were identified, establishing the diagnosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). A total cumulative dose of 60mg/kg of liposomal amphotericin B was administered, which resulted in clinical improvement and no rebleeding was observed. However, the patient died during hospitalization due to bacterial meningitis with septic shock.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Visceral leishmaniasis is a parasitic infection caused by Leishmania species. Leishmania infection is often asymptomatic, reflecting the ability of the host immune system to control the parasite.<a class="elsevierStyleCrossRef" href="#bib0030">1</a> However, reactivation can occur in the setting of immunosuppression, namely in the context of uncontrolled human immunodeficiency virus infection. In such cases, gastrointestinal involvement may occur and can be manifested with diarrhea, dysphagia, and abdominal pain.<a class="elsevierStyleCrossRef" href="#bib0035">2</a> Also, atypical presentation with intestinal involvement has been described in very few case reports, mainly in the small bowel.<a class="elsevierStyleCrossRefs" href="#bib0040">3,4</a> The course is usually characterized by treatment failure and the prognosis is poor.<a class="elsevierStyleCrossRef" href="#bib0040">3</a>The diagnosis of Leishmania relies mainly on visualization of the amastigote on histopathology. Other methods to establish the diagnosis are isolation by in vitro culture (only performed in reference laboratories), molecular detection of parasite DNA and serologic testing. If the parasite load is high enough, culture can be positive in two weeks but usually takes at least four weeks to obtain a result. In the absence of treatment, mortality rate can reach 90 percent. Liposomal amphotericin B has the highest therapeutic efficacy and the most favorable safety profile.<a class="elsevierStyleCrossRef" href="#bib0050">5</a> To the best of our knowledge, this is the first case reporting leishmania colitis manifested with lower gastrointestinal bleeding with hemodynamic instability, highlighting this rare entity in the differential diagnosis of acute colitis in immunosuppressed patients. Clinicians should maintain a high suspicion for unusual pathogens in an immunocompromised patient with intestinal lesions.Statement of ethicsThe patient has given written informed consent for publication (including the publication of images).FundingThe authors thank FCT/MCTES for the financial support to CiiEM (UIDB/04585/2020) through national funds.Authors’ contributionsFVL, HP, IM and CP wrote the manuscript. EF analyzed the computed tomography images. AET performed the histopathology evaluation. MP performed the colonoscopy. FMV performed clinical follow-up during hospitalization. JF and PPM critically reviewed the manuscript. All authors approved the final version of this paper.Conflict of interestThe authors have no conflicts of interest to declare.Data availability statementThe complete data of this study are not publicly available due to the patient's privacy but are available from the corresponding author upon reasonable request." "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Statement of ethics" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Authors’ contributions" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Data availability statement" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2338 "Ancho" => 3292 "Tamanyo" => 1037726 ] ] "descripcion" => array:1 [ "en" => "(A) Computed tomography showing pronounced circumferential wall thickening of the recto-sigmoid junction, measuring up to 14mm. (B) Colonoscopy revealing multiple circumferential irregular shaped ulcers and erosions with surrounding erythema, covered by white exudates in the recto-sigmoid junction. (C) Eosinophilic infiltration in the lamina propria and architectural distortion with granuloma formation and multinucleated giant (hematoxylin-eosin staining). (D) Intrahistiocytic microorganisms compatible with Leishmania amastigotes (Giemsa staining)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leishmaniasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Burza" 1 => "S.L. Croft" 2 => "M. Boelaert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(18)31204-2" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2018" "volumen" => "392" "paginaInicial" => "951" "paginaFinal" => "970" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30126638" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Visceral Leishmaniasis presenting with intestinal failure: a case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Hicks" 1 => "P. Kant" 2 => "P.H. Tay" 3 => "V. Vincini" 4 => "H. Schuster" 5 => "O. Rotimi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MEG.0b013e32830e6fdb" "Revista" => array:6 [ "tituloSerie" => "Eur J Gastroenterol Hepatol" "fecha" => "2009" "volumen" => "21" "paginaInicial" => "117" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19011572" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intestinal leishmaniasis: a rare case of enteropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Marinoni" 1 => "G.E. Tontini" 2 => "M. Maggioni" 3 => "S. Orlando" 4 => "F. Ferretti" 5 => "M. Vecchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/a-1122-8504" "Revista" => array:6 [ "tituloSerie" => "Endoscopy" "fecha" => "2020" "volumen" => "52" "paginaInicial" => "E335" "paginaFinal" => "E336" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32131089" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intestinal leishmaniasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Chattopadhyay" 1 => "S. Mittal" 2 => "K. Gupta" 3 => "V. Dhir" 4 => "S. Jain" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2020" "volumen" => "26" "paginaInicial" => "1345" "paginaFinal" => "1346" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and treatment of leishmaniasis: clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Aronson" 1 => "B.L. Herwaldt" 2 => "M. Libman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/ciw670" "Revista" => array:5 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2016" "volumen" => "63" "paginaInicial" => "e202" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27941151" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02105705/unassign/S0210570524002486/v1_202410150415/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/02105705/unassign/S0210570524002486/v1_202410150415/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570524002486?idApp=UINPBA00004N"]

ISSN: 0210-5705

See more Open Access Option

Indexed in:

SCIE/Journal of Citation Reports, Index Medicus/Medline, Excerpta Medica/EMBASE, SCOPUS, CANCERLIT, IBECS

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.2

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

1.5

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.263

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.306

View more metrics

Journal Information

Export reference

Download PDF

Article

These are the options to access the full texts of the publication Gastroenterología y Hepatología

Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”

Subscribe to

Gastroenterología y Hepatología

More information

Purchase

Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now

Contact

Phone for subscriptions and reporting of errors

From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.

Calls from Spain

932 415 960

Calls from outside Spain

+34 932 415 960

E-mail

atencionalcliente@elsevier.com

Publish in

Gastroenterología y Hepatología

Tools

Indexed in:

Follow us:

Subscribe:

Article

Subscribe to our newsletter