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Published on: March 25, 2014
Leishmaniasis diagnosed from bronchoalveolar lavage
1Department of Serology and Bacteriology, University of Helsinki, Finland.
Insights
A renal transplant patient with a history of splenectomy developed leishmaniasis, a parasitic infection, presenting as interstitial pneumonitis. Prompt diagnosis and treatment led to a full recovery, highlighting the importance of broad diagnostic methods.
Area of Science:
- Infectious Diseases
- Transplant Surgery
- Parasitology
Background:
- Renal transplant recipients with prior splenectomy are at increased risk for opportunistic infections.
- Leishmaniasis is a parasitic disease typically transmitted by sandflies, endemic in Mediterranean regions.
Observation:
- A 51-year-old patient, post-splenectomy and on immunosuppression, presented with fever and cough, initially suspected as pneumocystosis.
- Diagnosis of visceral leishmaniasis caused by Leishmania infantum was unexpectedly confirmed via bronchoalveolar lavage.
- The patient had recent travel history to Malaga, Spain, a known endemic area.
Findings:
- Isoenzyme typing confirmed the causative agent as Leishmania infantum.
- The patient's splenectomy and immunosuppressive therapy masked typical leishmaniasis symptoms, mimicking other pulmonary conditions.
- Treatment with specific antiparasitic medication resulted in rapid clinical improvement and sustained recovery over 1.5 years.
Implications:
- This case underscores leishmaniasis as a potential cause of interstitial pneumonitis in immunocompromised patients.
- It highlights the diagnostic challenge posed by atypical presentations in asplenic and immunosuppressed individuals.
- Emphasizes the utility of broad-spectrum diagnostic techniques for identifying diverse parasitic infections in clinical practice.
Abstract:
A 51-year-old renal transplant patient, whose spleen had been removed 11 years ago, was admitted to hospital for elective surgery, which was cancelled as she developed spiking fever and nonproductive cough and her general condition deteriorated. After 2 weeks, leishmaniasis was unexpectedly diagnosed from a bronchoalveolar lavage specimen, which had been subjected to parasitological examination under the suspicion of pneumocystosis. Isoenzyme typing identified the parasite as Leishmania infantum. The patient had visited Malaga, Spain, twice a year, the last trip taking place 1 month before admission. Specific treatment was followed by rapid recovery without relapse during 1.5 years. Splenectomy and immunosuppressive medication obscured the clinical suspicion of leishmaniasis. The case is a reminder of the interstitial pneumonitis in leishmaniasis and emphasizes the value of broad-spectrum methods detecting a variety of parasites.
