Case Report: The First Case Report of Visceral Leishmaniasis in Cambodia

Abstract

Leishmaniasis is considered a neglected tropical disease that is commonly found in Asia, Africa, South America, and Mediterranean countries. Visceral leishmaniasis (VL) is the most severe form of the disease and is almost universally fatal if left untreated. The symptoms of VL overlap with many infectious diseases, malignancies, and other blood disorders. The most common findings include fever, cytopenias, and splenomegaly. Given the nonspecific symptoms, the diagnosis requires detailed laboratory investigations, including bone marrow examination, that can be challenging in low- and middle-income countries. Diagnostic limitations likely lead to the underdiagnosis or delay in diagnosis of VL. We describe, to our knowledge, the first case report of VL in Cambodia in a child presenting with fever, anemia, and thrombocytopenia. The diagnosis required a liver biopsy and multiple bone marrow biopsies to visualize intracellular Leishmania spp. Our case illustrates the diagnostic challenges and the importance of timely diagnosis. This case also highlights the need for heightened awareness of the diagnostic findings of VL and improved reporting of tropical diseases.

Figure 1.

(A) Patient demonstrating abdominal distention on presentation. Blue outline indicates liver (left) and spleen (right) enlargement. (B) H&E stain of the patient’s bone marrow biopsy. (C) Giemsa stain of the patient’s bone marrow biopsy. (D) H&E stain of the patient’s liver biopsy. (E) Giemsa stain of the patient’s liver biopsy. Arrows showing amastigote form of leishmaniasis spp. This figure appears in color at www.ajtmh.org.