Kala-Azar: A Case Report

Abstract

Leishmaniasis is a zoonosis caused by unicellular protozoans Leishmania. The transmission can be zoonotic or anthroponotic, depending on the species, and the main vector is the phlebotomine sandfly. The disease is endemic in the tropics of Asia and Africa but is considered rare in Portugal, especially in immunocompetent hosts. Its main clinical syndromes constitute cutaneous leishmaniasis, mucocutaneous disease, and visceral leishmaniasis. The latter is also known as kala-azar and is caused by the infection of the phagocytes of the reticuloendothelial system, causing the typical symptoms: fever, hepatosplenomegaly, and pancytopenia. The clinical manifestations are non-specific, frequently causing a delay in the diagnosis, especially in nonendemic areas and immunocompetent hosts. Early diagnosis and treatment are essential, given the high mortality rate in untreated patients. The diagnosis is based on the direct visualization of the protozoan and molecular methods, such as polymerase chain reaction tests. Amphotericin B is considered the first-line treatment. We present a case of visceral leishmaniasis in an immunocompetent patient with fever, hepatosplenomegaly, and pancytopenia.

Keywords: high fever; immunocompetent adult; unintentional weight loss; visceral leishmaniasis (vl); “pancytopenia”.

Figure 1. Abdominal CT scan showing hepatosplenomegaly

CT: computerized tomography

Figure 2. Microscopical analysis of the bone marrow that shows normal cellularity (A). At 40x magnification, numerous macrophages with round and basophilic intracytoplasmic organisms that corresponded to Leishmania amastigotes are seen (B). These organisms are also readily visualized in a Giemsa staining (C)