Visceral leishmaniasis without fever in an 11-month-old infant: a rare clinical feature of Kala-azar

Abstract

Visceral leishmaniasis or kala-azar is an endemic parasitic disease in some parts of the world which is characterized by fever, splenomegaly, and pancytopenia in most of the cases. Herein we report an 11 month-old male infant with diagnosis of kala-azar who presented with pallor, hepatosplenomegaly, failure to gain weight, and no history of fever. Surprisingly, fever started after beginning of meglumine antimoniate treatment in this patient. As far as we are aware of, this is a rare presentation of visceral leishmaniasis. Therefore, clinicians especially in endemic areas are highly recommended to include kala-azar among differential diagnosis of unexplained anemia without fever to prevent misdiagnosis of this potentially fatal, but treatable condition.

Keywords: Leishmania infantum; afebrile; anemia; kala-azar; splenomegaly; visceral leishmaniasis.

Fig. 1

Bone marrow aspiration slide (Giemsa stain) showing Leishmania infantum bodies (arrow).

Fig. 2

Restriction fragment length polymorphism (RFLP) patterns obtained from Leishmania stocks and patient's sample. Lane 1, negative control; Lane 2, L. tropica; Lanes 3, 4, L. major; Lane 5, L. infantum; Lane 6, PCR product from patient's sample, L. infantum. M, 100-bp size marker (Fermentas).