Visceral Leishmaniasis-Like Cause of Unexplained Fever in a Reno-Pancreatic Graft Recipient

Visceral leishmaniasis after renal transplantation: report of 4 cases in northeastern Brazil

“…In our transplant unit we detected 4 cases among 100 renal transplanted patients (4%). Other studies have also found a similar association (9–11). The presence of fever and pancytopenia is highly suggestive of VL in immunosuppressed patients (12, 13).…”

New challenges in the epidemiology and treatment of visceral leishmaniasis in periurban areas

“…Araujo et al, [2010] reported a case of ileal L. i. chagasi in a patient who had received a cadaveric liver transplant and was maintained on tacrolimus and prednisone. In addition to liver and kidney, VL has been reported in patients post-transplant for lung, heart, and combined kidney-pancreas [Larocca et al, 2007; Morales et al, 2003; Torregrosa et al, 1993]. Campos-Varela et al [2008] reported on nine cases of VL in liver transplant patients.…”

Visceral Leishmaniasis: A Rare Cause of Unexplained Pyrexia in a Renal Allograft Recipient

“…To the best of our knowledge, only 12 cases, including this report, of visceral leishmania sis in renal allograft recipients have been described so far [2][3][4][5]. Four of these patients (33.3%) had a fatal outcome mainly due to supcrinfection, most often Pseudomonas septicemia, or disseminated intravascular coagulation [2,3], and only 8 patients (66.6%) have survived after antiprotozoal therapy [4,5], The outcome depends on ear ly diagnosis and treatment -which may be delayed because this diagnosis is often not considered in the first place and secondly because of a misleading presentation of the disease in such immunocompromised hosts. The optimum dosage and duration of treat-ment in such patients is also not clearly defined as is demonstrated by the various treatment schedules and outcome reported in the literature [2][3][4][5].…”

“…However, im munodeficiency states can facilitate the reac tivation of a dormant illness in infected pa tients or predispose such patients to infec tion in endemic areas. Indeed, following its first description in renal transplant recipi ents in 1979 [1], in recent years more case reports have described such an association [2][3][4][5]. In contrast to the non-immunodeficient patients, the disease is often more ful minant and poorly responsive to therapy in these high risk patients [3].…”

“…Four of these patients (33.3%) had a fatal outcome mainly due to supcrinfection, most often Pseudomonas septicemia, or disseminated intravascular coagulation [2,3], and only 8 patients (66.6%) have survived after antiprotozoal therapy [4,5], The outcome depends on ear ly diagnosis and treatment -which may be delayed because this diagnosis is often not considered in the first place and secondly because of a misleading presentation of the disease in such immunocompromised hosts. The optimum dosage and duration of treat-ment in such patients is also not clearly defined as is demonstrated by the various treatment schedules and outcome reported in the literature [2][3][4][5]. However, a close fol low-up is essential after effective treatment since relapses have been described occurring even after I year of apparent cure, necessi tating successful rctrcatmcnt with either pcntavalent antimonials again or with other antileishmanial drugs, like allopurinol and amphotericin [3],…”