Visceral leishmaniasis (VL) has clinical manifestations that may overlap with those of systemic lupus erythematosus (SLE) resulting in diagnostic error.
Possible diagnostic errors:
(1) visceral leishmaniasis as an exacerbation of SLE
(2) visceral leishmaniasis as the initial presentation of SLE
(3) SLE as an exacerbation of visceral leishmaniasis
Clinical findings in visceral leishmaniasis may include:
(1) intermittent fevers
(2) pancytopenia
(3) hepatomegaly and/or splenomegaly
(4) serum acute phase reactants
(5) autoantibodies (antinuclear antibodies, rheumatoid factor, direct antiglobulin test)
Reasons to suspect visceral leishmaniasis:
(1) failure to respond as expected to corticosteroids
(2) normal serum concentration of C3 and C4
(3) massive splenomegaly
(4) presence of anti-Leishmania antibodies (may be negative in SLE)
(5) high serum concentrations of CRP
If the patient is misdiagnosed as having an exacerbation of SLE then therapy with immunosuppressive therapy can lead to rapid progression of the VL.
