Case Summary
A patient presented with a five-month history of progressive body
weakness, dizziness, night sweats and weight loss. He had normal vital
signs except a fever of 38.10C. On examination, he had
punctate oral sores, pallor, massive splenomegaly (10cm), and
hepatomegaly (4cm). Hemogram showed marked pancytopenia. Bone marrow
aspirate was hypercellular spicules with increased plasma cells and
numerous amastigotes extracellularly and intracellularly within
reticuloendothelial cells (Figure 1, Figure 2). The patient was
confirmed to have visceral leishmaniasis with a positive history of
travel to a leishmania endemic region in Kenya. He was started on Sodium
stibogluconate intravenously at 20/kg/day for 28 days and showed
excellent recovery.
Leishmaniasis is common in
tropical and sub-tropical areas and is caused by vector-borne protozoal
parasites of the genus Leishmania. It is transmitted through the
bites of infected haematophagous female sandflies (genera:Phlebotomus and Lutzomyia). Clinical presentation can be variable
depending on the type of species and nature of immune response
elicited1,2. The most common clinical presentation
includes systemic or disseminated disease and cutaneous and mucosal
lesions. The diagnosis requires a high index of suspicion in a patient
with consistent symptoms in the proper epidemiological context requiring
a combination of clinical, parasitological, molecular and serologic
tests.