Objectives: Classic visceral leishmaniasis presents as fever, hepatosplenomegaly and pancytopenia. Fever is almost always present at the time of medical consultation. We will present a case of leishmaniasis without fever in an immunocompetent individual. Case report: A 67-year-old man was admitted in our department due to fatigue, splenomegaly and elevated serum IgG. He never had fever during his illness. In his neighbourhood he had dogs. From his medical history we noted a mild diabetes mellitus, gastritis, appendicectomy, surgical extraction of gall bladder, and thrombocytosis of unknown origin a year before, that yielded without any treatment. Upon admission he had temperature 36.5Â°C. Physical examination revealed a slight paleness, spleen enlargement (~ 8cm below the left costal margin), small nontender cervical lymphnodes and a maculopapular rash of the front thoracic side. Blood analysis revealed hematocrit 35%, haemoglobin 12g/dl, leucocytes 3470/mm3 (granulocutes 40%), platelets 299000/mm3 (seriously decreased compared to those of a year before), erythrocyte sedimentation rate of 90 mm/h, C-reactive protein 0.4 mg/dl and serum IgG 6870 mg/dl, with a small IgG-k band. Chest radiograph and bone scan were normal. CT scan of chest and abdomen showed only splenomegaly. Bone marrow biopsy and aspirate revealed no haematological malignancy. The bone marrow smear revealed a good deal of Leishmania amastigotes and PCR for Leishmania from bone marrow was also positive. Leishmania serum fluorescent antibodies were positive (1/320). The patient was administered liposomal amphotericin-B 2 mg/kg/day for 5 days and another 2 mg/kg eight days later. After 1 month the patient is doing well, the spleen and lymphnodes are no more palpable, the rash has disappeared and the laboratory values are within normal range. Conclusion: Mild leishmaniasis -as the one described above- is becoming more and more frequent in the developed and developing world. Therefore, unexplained constitutional symptoms those appear within two years after exposure to an endemic area might warrant investigation for infection with Leishmania.
Full conference title:
16th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 16th (2006)