[Visceral leishmaniasis and multiple organ failure]

Visceral leishmaniasis is a parasitic disease which has a good prognosis in previously healthy patients who have been successfully treated. At present, visceral leishmaniasis is increasingly reported in immunocompromised patients including those with AIDS, whose display a fulminating form and higher mortality. We report a case of visceral leishmaniasis in a healthy patient with a non classical clinical evolution of the disease.

A 17 years old patient without immunosuppressive factors was diagnosed by histologic evaluation of bone marrow which revealed intracellular leishmania amastigotes. Immediately the patient received treatment with antimony therapy.

Patient developed a multi-organic failure (respiratory distress, disseminated intravascular coagulation, hepatic and renal insufficiency) and died at 13 days his after intensive care unit admission.

The major new finding of this study is that in normal humans visceral leishmaniasis can have a dramatic short-term follow up in spite of correctly treatment. We suggest a possible immunological mechanism similar at non septic pathology.