Imported Visceral Leishmaniasis in Timiș County, Western Romania

Visceral leishmaniasis (VL) is a rare but increasingly recognized parasitic infection in non-endemic European regions, including Romania. We report two cases of VL diagnosed in Timiș County, Western Romania, in 2020: a 57-year-old male presenting with fever, massive splenomegaly, and severe pancytopenia, and a 51-year-old male presenting atypically with fatigue, bicytopenia, and absence of organomegaly. Both patients were diagnosed through bone marrow aspirate examination revealing Leishmania amastigotes. Both cases were classified as imported VL, with exposure linked to endemic regions of eastern Spain (Castellón and València). These cases highlight the importance of maintaining a high index of clinical suspicion for VL in patients presenting with unexplained cytopenias and elevated inflammatory markers, even in the absence of classic features such as hepatosplenomegaly. The present report underscores the relevance of travel history in non-endemic regions such as Romania and the need for clinical awareness of imported VL in patients returning from endemic areas of southern Europe.