Article: article from journal or magazin.
Case report (case report): feedback on an observation with a short commentary.
AA-amyloidosis caused by visceral leishmaniasis in a human immunodeficiency virus-infected patient.
American Journal of Tropical Medicine and Hygiene
Publication types: Case Reports ; Journal Article
AA-amyloidosis in the setting of chronic visceral leishmaniasis (VL) has been reported in animal models but documentation in humans is unavailable. Here, we report on a Portuguese man who in 1996 was diagnosed with both human immunodeficiency virus (HIV)-infection and VL. Antiretroviral treatment led to sustained suppression of HIV viremia but CD4+ lymphocytes rose from 8 to only 160 cells/mL. Several courses of antimony treatment did not prevent VL relapses. Renal failure developed in 2006 and renal biopsy revealed AA-amyloidosis. The patient had cryoglobulinemia and serum immune complexes containing antibodies directed against seven leishmanial antigens. Antimony plus amphotericin B, followed by oral miltefosine resulted in a sustained VL treatment response with elimination of circulating Leishmania infantum DNA and CD4+ recovery. The concomitant reduction of serum AA levels and disappearance of circulating leishmanial immune complexes suggests that prolonged VL may lead to AA-amyloidosis in immunocompromised humans.
Amphotericin B/therapeutic use, Amyloidosis/complications, Anti-HIV Agents/therapeutic use, Antiprotozoal Agents/therapeutic use, HIV Infections/complications, HIV Infections/drug therapy, Humans, Leishmaniasis, Visceral/complications, Leishmaniasis, Visceral/drug therapy, Male, Meglumine/therapeutic use, Organometallic Compounds/therapeutic use, Young Adult
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