PMC4549335_01
(A) Trend of CD4 count, haemoglobin, platelet count and absolute neutrophil count, prior to treatment with liposomal daunorubicin 1993-2012.. (B) Trend of CD4 count, haemoglobin, platelet count and absolute neutrophil count, September 2012-August 2013.
pntd.0003983.g001.jpg
PMC4549335_01_pntd.0003983.g001.jpg
pntd.0003983.g001
Despite this, his CD4 count, which had a nadir of 39 in 1996, never rose above 140 despite consistent adherence to his ART (Fig 1A). Each treatment resulted in a temporary worsening of his pancytopenia but there were no significant infectious, bleeding or other adverse effects (Fig 1B).
(A) Abdominal computerised tomography (CT) scanning conducted in May 2012.. Before treatment with liposomal daunorubicin. (B) Abdominal computerised tomography (CT) scanning conducted in July 2013. After treatment with liposomal daunorubicin, demonstrating no decrease in the patient's hepato-splenomegaly.
pntd.0003983.g002.jpg
PMC4549335_01_pntd.0003983.g002.jpg
pntd.0003983.g002
There was no decrease in his splenomegaly either on clinical examination or on abdominal imaging (Fig 2).
(A) Haematoxylin and eosin stained bone marrow trephines obtained in February 2011 showing occasional amastigotes (white arrow).. (B) Haematoxylin and eosin stained bone marrow trephines obtained in February 2013 after liposomal daunorubicin treatment showing a heavy parasite load (black arrows).
pntd.0003983.g003.jpg
PMC4549335_01_pntd.0003983.g003.jpg
pntd.0003983.g003
The density of amastigotes in the bone marrow trephine collected 7 days after the last dose of daunorubicin was greater than that in the most recent previous trephine which had been collected in February 2011 (Fig 3).