Lymphoma or Leishmaniasis??

Abdominal Ultrasound Findings Associated with Canine Visceral Leishmaniasis in Endemic Areas

Paola Paradies, Mario Cipone, Italia Mele, Beatrice Greco, Daniela Romano, Mariateresa Sasanelli

Background
Canine visceral leishmaniasis (CVL), caused by Leishmania infantum, is a vector-borne disease prevalent in Mediterranean regions. Diagnosing CVL is challenging due to its nonspecific clinical signs and variable test results. This study aimed to characterize abdominal ultrasound (US) findings in dogs naturally infected with L. infantum and assess US changes post-treatment.

Methods
Thirty-four dogs from an endemic area (Apulia, Italy) were diagnosed with L. infantum via lymph-node smears and IFAT tests. Abdominal US exams were conducted at diagnosis and repeated post-treatment when possible. Morphological and echogenicity changes in abdominal organs, including spleen, liver, kidneys, and lymph nodes, were recorded. Statistical correlations were analyzed between US findings, clinical scores, and laboratory results.

Results
Initial US Findings:
-Spleen: Splenomegaly (70%) with hypoechoic or inhomogeneous parenchyma; "honeycomb" appearance in 2 dogs.
-Kidneys: Increased cortical echogenicity in 41%; reduced cortico-medullary definition in 9%.
-Liver: Hepatomegaly in 21%; increased echogenicity in 9%; cirrhotic-like changes in 2 cases.
-Lymph Nodes: Abdominal lymphadenopathy in 15%, some without peripheral node involvement.
-No focal macro-nodular lesions in the liver or spleen were observed.

Post-Treatment Follow-up:
-Resolution of most US abnormalities, including splenomegaly, liver changes, and lymphadenopathy, was observed.
-Some new findings post-treatment included kidney and bladder mineralizations, likely linked to prolonged allopurinol therapy.

Correlations:
-Splenic echogenicity showed significant correlations with clinical scores (negative) and hematocrit (positive), indicating its potential as an early marker of systemic involvement.

Limitations
The study was limited by its sample size and lack of systematic histological confirmation of US findings.
Post-treatment follow-up data were available for only 11 dogs, reducing the ability to generalize recovery trends.

Conclusions
Ultrasound is a valuable tool for detecting systemic involvement in CVL and monitoring treatment response. Unique findings, like the splenic "honeycomb" pattern, should prompt consideration of CVL in differential diagnoses. Further studies are needed to evaluate macro-nodular lesions in larger populations and refine diagnostic applications.

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