Case Report: Combination Therapy with Liposomal Amphotericin B, N-Methyl Meglumine Antimoniate, and Pentamidine Isethionate for Disseminated Visceral Leishmaniasis in a Splenectomized Adult Patient

Abstract

In immunocompromised patients, visceral leishmaniasis (VL) can present with atypical clinical symptoms that include poor response to treatment. No optimal therapeutic regimen is available for such cases. In a splenectomized male patient, we observed a disseminated form of the disease in the liver, bone marrow, lymph nodes, and gastrointestinal tract. There was an apparent clinical improvement when he was initially treated with liposomal amphotericin B (L-AmB), but this was followed by a relapse involving severe clinical symptoms. He was finally treated successfully with a combination of L-AmB, meglumine antimoniate, and pentamidine isethionate. It is important to include asplenia as an immunosuppressive condition that induces exotic VL pathologies. In such cases, combination anti-Leishmania drug therapy should be considered.

Figure 1.

Photomicrography of the patient’s inguinal lymph node biopsy. Hyperplasia of lymphoid and histiocytic tissue with granulomatous organization, visualized at ×100 magnification (A), exhibiting amastigote forms of Leishmania (arrowhead) inside epithelioid histiocytes stained with Giemsa, visualized at ×400 (B) and, especially, at ×1,000 magnification (C). This figure appears in color at www.ajtmh.org.