Kala-azar: liver fine needle aspiration findings in 23 cases presenting with a fever of unknown origin.

OBJECTIVE

To study the role of liver fine needle aspiration (FNA) in the diagnosis of kala-azar with an atypical presentation.

STUDY

DESIGN

The study group consisted of 23 patients (aged 18-37). All were admitted to Shiraz University Hospitals for the investigation of fever of unknown origin. The immunofluorescent antibody titer for kala-azar was positive (> 1:256 dilution). However, routine abdominal sonography revealed multiple small, hypoechoic lesions in the liver, more suggestive of metastatic tumor or miliary tuberculosis. The lesions were aspirated for cytologic diagnosis.

RESULTS

The smears revealed many atypical hepatocytes, groups of epithelioid histiocytes and, in 15 patients, macrophages containing few to many Leishman bodies, allowing a diagnosis of kala-azar. The liver needle biopsy specimens confirmed the cytologic diagnosis of kala-azar and liver cell atypia. The patients were given glucantime therapy, and 21 recovered; 1 patient was lost to follow-up, and 1 died during treatment.

CONCLUSION

Liver FNA is a useful procedure for the diagnosis of kala-azar, particularly in cases with atypical clinical presentations.