A Rare Presentation of Leishmaniasis

Area of Science:

• Tropical Medicine
• Parasitology
• Internal Medicine

Background:

• Leishmaniasis, or kala-azar, is a protozoan disease with various clinical presentations, including visceral leishmaniasis (VL).
• VL primarily affects the liver, spleen, and bone marrow, presenting with symptoms like prolonged fever, splenomegaly, anemia, and pancytopenia.
• Diagnosis typically relies on bone marrow biopsy or splenic aspirates, especially in endemic regions of India.

Purpose of the Study:

• To report an atypical case of visceral leishmaniasis in a patient residing outside an endemic area.
• To highlight the diagnostic challenges when initial bone marrow biopsies are negative for Leishmanin Donovan (LD) bodies.

Main Methods:

• A case study of a 52-year-old patient with pyrexia of unknown origin.
• Initial diagnostic attempts included bone marrow biopsy, which was negative for LD bodies.
• Diagnosis was confirmed through liver biopsy, revealing the presence of LD bodies.

Main Results:

• The patient, a non-resident of a known endemic area, presented with symptoms suggestive of visceral leishmaniasis.
• Bone marrow biopsy failed to detect Leishmanin Donovan (LD) bodies, complicating the diagnosis.
• Liver biopsy successfully identified LD bodies, confirming the diagnosis of visceral leishmaniasis.

Conclusions:

• Visceral leishmaniasis can occur in non-endemic areas and present atypically.
• Liver biopsy can be a crucial diagnostic tool for visceral leishmaniasis when bone marrow examinations are inconclusive.
• This case underscores the need for a broad differential diagnosis and consideration of alternative biopsy sites in suspected leishmaniasis cases.