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Visceral leishmaniasis (Kala-Azar) in transplant recipients: case report and review
J Berenguer1, F Gómez-Campderá, B Padilla
1Servicio de Microbiología Clínica y Unidad de Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Background:
In endemic areas, visceral leishmaniasis has been identified as an opportunistic infection in patients with derangements in their cellular immune system.
Methods:
We report a renal transplant patient with visceral leishmaniasis. We also reviewed the previously published cases of 17 organ transplant recipients with this parasitic disease.
Results:
Visceral leishmaniasis occurred a median time of 8 months after transplantation, and the clinical picture was characterized by fever, splenomegaly, and blood cytopenias. Leishmaniae were detected in bone marrow in 16 of 18 patients and diagnostic serology results were found in 8 of 10 tested patients. Pentavalent antimonials were used to treat 16 patients, five of which developed pancreatitis. Five of 18 patients died, including two untreated patients. Relapses of visceral leishmaniasis occurred in 4 of 13 survivors.
Conclusions:
In endemic areas, visceral leishmaniasis may complicate the clinical course of organ transplantation and can have fatal consequences, particularly when untreated.