KALA-AZAR ASSOCIATED WITH COOMBS-POSITIVE AUTOIMMUNE HEMOLYTIC ANEMIA IN THE PATIENTS COMING FROM THE ENDEMIC AREA OF THIS DISEASE AND SUCCESSFUL TREATMENT OF THESE PATIENTS WITH LIPOSOMAL AMPHOTERICIN B

Abstract

Kala-azar is an intracellular parasitic infection that infects and multiplies in the macrophages of the liver, the spleen, and the bone marrow. It is characterized by intermittent fever, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Although anemia is a usual finding, Coombs-positive autoimmune hemolytic anemia (AIHA) has rarely been reported with this disease. Pentavalent antimonial compounds remain the mainstay of treatment worldwide. Liposomal amphotericin B (L-AmB) is currently preferred in the treatment of kala-azar because of the resistance to pentavalent antimonals. The authors diagnosed kala-azar associated with Coombs-positive AIHA in 3 patients and treated them with L-AmB (1–5 mg/kg/day) for 30–36 days. Now, all of these patients are healthy following up at the outpatient base for 18–34 months. Kala-azar must be considered in patients with Coombs-positive AIHA and living in and coming from the endemic region for this disease, and it can be successfully treated with L-AmB.

Keywords:

• Coombs-positive immune hemolytic anemia
• kala-azar
• liposomal amphotericin B