Intraretinal hemorrhage associated with leishmaniasis

A 39-year-old man presented with sudden loss of visual acuity caused by two retinal hemorrhages with no choroidal neovascularization (confirmed by fluorescein angiography). The patient was hospitalized for malaise, progressive pancytopenia, hepatosplenomegaly, progressive anemia, and perianal inflammation. Positive serologies were obtained for toxoplasmosis (IgG) and Leishmania (1/160). A diagnosis of visceral leishmaniasis was made, and the patient was treated with pentavalent antimonials. Two months later, best-corrected visual acuity was 20/25, with no residual scotoma. Indirect ophthalmoscopy showed complete resolution of the hemorrhages. This patient was an otherwise healthy immunocompetent adult who presented frank visceral leishmaniasis and retinal hemorrhages as the only ocular or systemic hemorrhagic findings, with spontaneous resolution after improvement of platelet levels. This rare cause of macular hemorrhage should be considered in areas where Leishmania is endemic.