Mediterr J Rheumatol 2021;32(2):160-3
A Patient with Rheumatoid Arthritis under Methotrexate and Etanercept Treatment Presenting with Fever and Pancytopenia: An Unexpected Guest
Authors Information

1. First Department of Internal Medicine, General Hospital of Thessaloniki “Hippokration”, Thessaloniki, Greece

2. Haematology Section, Second Propaedeutic Department of Internal Medicine, General Hospital of Thessaloniki “Hippokration”, Aristotle University of Thessaloniki, Thessaloniki, Greece

Patoulias D


Leishmania species induce chronic intracellular parasitism, while visceral leishmaniasis can become fatal, if left untreated. Patients with rheumatoid arthritis might feature a genetic predisposition to infection from Leishmania species, besides the status of immunosuppression. Several cases of visceral leishmaniasis in patients with underlying rheumatoid arthritis manifesting with cytopenias with or without organomegaly have been published so far; however, only three cases presenting with pancytopenia without splenomegaly have been described. Herein we describe a case of a 63-year-old woman presenting with fever and pancytopenia without organomegaly on a background of rheumatoid arthritis under methotrexate and etanercept treatment, finally diagnosed with visceral leishmaniasis.

Article Submitted: 8 Aug 2020; Revised Form: 26 Jan 2021; Article Accepted: 15 Feb 2021; Available Online: 28 May 2021 


This work is licensed under a Creative Commons Attribution 4.0 International License (CC-BY). 

©Patoulias D, Papachristou S, Gouridou E, Stamou D, Chissan S, Bakatselos S.