A Rare Presentation of Leishmaniasis

Abstract

Leishmaniasis or kala-azar is a protozoan disease that can present as cutaneous, mucocutaneous, visceral, and disseminated disease. In India, it is usually localized in distinct areas of Bihar, Jharkhand, West Bengal, and parts of Eastern Uttar Pradesh. Visceral leishmaniasis (VL) involves the visceral organs, mainly the liver, the spleen and bone marrow. VL is characterized by prolonged fever, massive splenomegaly, weight loss, progressive anemia, pancytopenia, and hypergammaglobulinemia, and can be complicated by serious infections. In most of the patient the diagnosis is made on bone marrow biopsy or splenic aspirate. We hereby present an unusual case of kala-azar in a 52-year-old patient non-resident of endemic area presenting with pyrexia of unknown origin, in whom bone marrow biopsy was negative for Leishmanin Donovan (LD) bodies, and diagnosis was made by liver biopsy in which LD bodies were seen.

<p>Alteration of Clinical Chemistry Parameters Among Visceral Leishmaniasis Patients in Western Tigrai, Ethiopia, 2018/2019: A Comparative Cross-Sectional Study</p>

“…Furthermore, different case reports supported the present study and reported liver dysfunction with the raised value of serum AST, ALT, and bilirubin from VL patients. [14][15][16][17][18][19] Similarly, studies conducted in India and Bangladesh also reported abnormally high liver inflammatory enzymes like ALT, AST, and ALP in VL patients. 6,20 This may be attributed to the levels of particular circulating cytokines during the inflammatory processes observed in active VL disease could be a determinant and consequence of severe liver disease.…”

“…Besides different case reports conducted in India, Turkey, and a cohort study conducted in Brazil showed that elevated total and direct bilirubin in VL patients. 18 , 19 , 23 This may attribute to hemolysis of red blood cells and sequestration and destruction of red blood cells (RBC) in enlarged spleen of VL patients. 24 However, this study was not in agreement with the study conducted in Iraq and which were reported no significant difference in the mean value of serum bilirubin between VL patients and healthy controls.…”

Hematological Characteristics of Yemeni Adults and Children With Visceral Leishmaniasis. Could Eosinopenia Be a Suspicion Index?

“… 25 , 35 Severe anemia, malnutrition and long duration of illness were shown to be associated with an increased risk of death. 25 , 36 These issues should be addressed in evaluating and managing patients with VL. The marked bone marrow eosinopenia associated with marked peripheral blood eosinopenia are the characteristics which were most common in our patients with VL and usually are not reported both together in other simulating illnesses.…”

Utility of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Visceral Leishmaniasis: Case Report and Literature Review

“…In 27 cases, enhanced uptake was seen in the bone marrow. Of these, five cases were IS patients, 9,20,21,24,25 20 cases were in immunocompetent patients, 7,14,15,18,22,23,26,29 and in two cases, the immune state was unknown. 19,27 Bone marrow biopsy revealed Leishmania spp.…”

“…in three non-IS patients. 14,15,18 Of the remaining cases with enhanced bone marrow uptake, three biopsies were negative 22,23,29 and 14 cases did not undergo bone marrow biopsy or had no information available. 7,26 Lymph node involvement was only mentioned in 13 cases (five IS [8][9][10]21,24 and eight non-IS 7,16,28 ).…”