Case Report: Leishmaniasis in a 33-Year-Old Man with Multiple Sclerosis

Area of Science:

• Immunology
• Infectious Diseases
• Neurology

Background:

• Leishmaniasis is a protozoan disease with increased severity and treatment resistance in immunosuppressed individuals.
• The use of immunomodulatory drugs for conditions like multiple sclerosis (MS) is rising, potentially increasing opportunistic infections.
• Understanding the interplay between MS treatments and leishmaniasis risk is critical in endemic regions.

Observation:

• A case of visceral leishmaniasis is presented in a multiple sclerosis patient undergoing fingolimod therapy.
• The patient exhibited classic symptoms including fever, enlarged spleen and liver, and pancytopenia.
• Diagnosis was confirmed by identifying amastigotes in a bone marrow aspirate.

Findings:

• Fingolimod, an immunomodulatory drug for MS, may be associated with an increased risk of visceral leishmaniasis.
• The patient's presentation with fever, visceromegaly, and pancytopenia is characteristic of visceral leishmaniasis.
• Microscopic identification of amastigotes in bone marrow confirmed the diagnosis.

Implications:

• This case highlights the importance of considering leishmaniasis in immunocompromised patients, particularly those on novel immunosuppressants.
• Clinicians should maintain a high index of suspicion for leishmaniasis in MS patients residing in or traveling to endemic areas.
• Further research into the specific risks and management strategies for leishmaniasis in MS patients on immunosuppressive therapy is warranted.