[Fever, pancytopenia, and splenomegaly 8 months after a trip to Majorca Island (Spain)]

Abstract

Background: Visceral leishmaniasis is a rare imported infectious disease in Germany. Approximately ten to 30 cases are recorded annually. The classic symptoms are often misinterpreted as lymphoma of the spleen.

Case report: A 46-year-old patient presented with fever, malaise, night sweats, pancytopenia, and splenomegaly 8 months after a 2-week trip to Majorca Island (Spain). Bone marrow biopsy showed no evidence of malignant lymphoma. Serology confirmed the suspected clinical diagnosis of visceral leishmaniasis. Cytology and polymerase chain reaction from bone marrow aspirate were positive for Leishmania infantum. Treatment with liposomal amphotericin B was initiated and led to complete recovery.

Conclusion: Visceral leishmaniasis is an important differential diagnosis for the clinical triad of fever, pancytopenia, and splenomegaly. An accurate travel history is therefore of paramount importance. Without treatment, the case fatality rate is high. A complete recovery is usually achieved with adequate therapy (liposomal amphotericin B, miltefosine).