Visceral leishmaniasis with cysticercosis

Area of Science:

• Parasitology
• Infectious Diseases
• Medical Zoology

Background:

• Kala-azar, also known as visceral leishmaniasis, is a severe parasitic disease caused by Leishmania donovani.
• Relapsed cases of kala-azar can present with atypical or disseminated manifestations.
• Chest wall nodules are an uncommon presentation of parasitic infections.

Observation:

• A cysticercus was identified within a chest wall nodule in a pediatric patient with a history of relapsed kala-azar.
• The nodule's fibrous wall exhibited lymphohistiocytic aggregates.
• Mononuclear phagocytes within the nodule's wall were observed to contain amastigotes of Leishmania donovani.

Findings:

• The presence of Leishmania donovani amastigotes within mononuclear phagocytes in a chest wall nodule confirms parasitic infiltration.
• The cysticercus suggests a co-infection or a misdiagnosis, highlighting the importance of comprehensive parasitic evaluation.
• This finding demonstrates an unusual extranodal site for Leishmania amastigotes in a relapsed case.

Implications:

• This case highlights the potential for Leishmania donovani to manifest in extranodal sites, even in the chest wall.
• Accurate diagnosis of parasitic infections requires consideration of diverse clinical presentations and potential co-infections.
• Understanding atypical parasite localization is crucial for effective treatment and management of relapsed visceral leishmaniasis.