Journal of Postgraduate Medicine
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Year : 2015  |  Volume : 61  |  Issue : 2  |  Page : 145  

Offender: Virus or parasite or both

P Chhabra 
 Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Haryana and Punjab, India

Correspondence Address:
P Chhabra
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Haryana and Punjab

How to cite this article:
Chhabra P. Offender: Virus or parasite or both.J Postgrad Med 2015;61:145-145

How to cite this URL:
Chhabra P. Offender: Virus or parasite or both. J Postgrad Med [serial online] 2015 [cited 2022 Dec 5 ];61:145-145
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A very interesting report has been described by the authors, in which a toddler developed hemophagocytic lymphohistiocytosis (HLH) after coinfection with Epstein-Barr virus (EBV) and Leishmania. [1] We also had experience with EBV infection where the clinical profile was suggestive of acute leukemia in two patients, but ultimately one was diagnosed as having infectious mononucleosis while the other was found to have HLH. [2] The case described by the authors is unique in many aspects. Primary HLH is more commonly seen in infants as compared to adults although the latter are not immune from HLH secondary to infections. The toddler here had a coinfection with EBV as well as leishmania. A workup for secondary immunodeficiency should also have been done, including serology against human immunodeficiency virus (HIV). Antibody to rK39 antigen carries a sensitivity and specificity above 90% for diagnosis of visceral leishmaniasis and can help to avoid costly tests like polymerase chain reaction (PCR). [3] It is not mentioned whether Antibody against rK39 antigen was done or not. Whether HLH was due to EBV or Leishmania or was a combined effect of both is difficult to say as both are common etiological agents of HLH, though EBV is more common. Moreover, fever can respond to amphotericin in febrile neutropenia due to acquired infections, apart from leishmania.


1DomInguez-Pinilla N, Baro-Fernández M, González-Granado LI. Hemophagocytic lymphohistiocytosis secondary to Epstein Barr virus and Leishmania co-infection in a toddler. J Postgrad Med 2015;61:44-5.
2Chhabra P, Law AD, Sharma U, Suri V, Sachdeva MS, Kumari S, et al. Epstein-barr virus infection masquerading as acute leukemia: A report of two cases and review of literature. Indian J Hematol Blood Transfus 2014;30:26-8.
3Sundar S, Singh RK, Bimal SK, Gidwani K, Mishra A, Maurya R, et al. Comparative evaluation of parasitology and serological tests in the diagnosis of visceral leishmaniasis in India: A phase III diagnostic accuracy study. Trop Med Int Health 2007;12:284-9.

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