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[Leptospira, does it simulate or cause leukemia?].

Oscar Velasco-Castrejón1, Beatriz Rivas-Sánchez, Esther Gutiérrez

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Leptospirosis can mimic leukemia, causing bleeding disorders. Early detection using specialized stains and immunofluorescence in bone marrow is crucial for effective treatment and public health awareness.

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Area of Science:

  • Hematology
  • Infectious Diseases
  • Pathology

Background:

  • Leptospirosis is an infectious disease caused by Leptospira spirochetes.
  • It can present with diverse clinical manifestations, sometimes mimicking hematological malignancies.

Observation:

  • Two patients with bicytopenia and pancytopenia, respectively, presented with bleeding and were initially diagnosed with leukemia.
  • Despite treatment for leukemia, one patient improved significantly with high-dose penicillin.
  • Histopathology revealed leptospires in bone marrow and other organs, not neoplastic cells.

Findings:

  • The histopathological diagnoses were generalized leptospirosis with medullary aplasia and myelodysplastic syndrome.
  • Leptospira infection was confirmed via Warthin-Starry staining and immunofluorescence.
  • The study suggests Leptospira may induce leukemoid reactions or be misdiagnosed as leukemia.

Implications:

  • Hematologists and pathologists should consider leptospirosis in patients with unexplained cytopenias and bleeding.
  • Advanced diagnostic techniques like silver staining and immunofluorescence are vital for detecting leptospires, especially in seronegative cases.
  • Accurate diagnosis of leptospirosis is essential for effective treatment and public health surveillance, challenging the perceived low impact of this spirochetosis.