[Leishmaniasis: case report]

Area of Science:

• Parasitology
• Infectious Diseases
• Internal Medicine

Background:

• Leishmaniasis is a chronic parasitic disease affecting the reticuloendothelial system, presenting with diverse clinical manifestations including visceral, cutaneous, and mucocutaneous forms.
• This case report details the diagnosis and successful treatment of a patient with visceral leishmaniasis at the Clinic for Infectious Diseases in Novi Sad.

Observation:

• A 22-year-old patient presented with a month-long history of malaise, fatigue, anorexia, intermittent fever, night sweats, dark urine, and left upper quadrant pain.
• Clinical examination revealed dehydration, intoxication, subicteric sclerae, hepatomegaly, and extreme splenomegaly. Laboratory tests showed anemia, leucopenia, elevated gamma globulins, and hypercellular bone marrow.
• Epidemiological history indicated potential exposure to Phlebotomus genus mosquitoes in the Adriatic coastal region two years prior.

Findings:

• Diagnosis was confirmed by a positive formol-gel test, indirect hemagglutination test, and the presence of Leishmania donovani in bone marrow aspirates.
• Treatment with N-methyl-glucamine-antimonate (Glucantime) for three weeks resulted in complete clinical cure.
• A one-year follow-up demonstrated normalization of laboratory parameters and ultrasonographic findings of the liver and spleen.

Implications:

• The polymorphic and gradual onset of leishmaniasis necessitates broad diagnostic considerations, even in regions where it is considered rare.
• Early and accurate diagnosis is crucial for initiating appropriate therapy, thereby preventing potentially fatal outcomes.
• This case underscores the importance of considering leishmaniasis in the differential diagnosis of febrile illnesses with hepatosplenomegaly and hematological abnormalities.