title: Visceral Leishmaniasis in renal transplant recipients: is it still a challenge to the nephrologist?
abstract: A case of visceral Leishmaniasis in a renal transplant recipient is reported because of its peculiar clinical presentation: the presence of most clinical signs of the disease, such as high-grade fever, marked leucopenia, and splenomegaly, but persistent negativity of serology and of bone marrow smear. Forty days after the first bone marrow biopsy, the diagnosis was made possible by a second biopsy, and the treatment was started with antimonial compounds, which led to complete remission of symptoms. A relapse was observed 1 month after discontinuation of therapy, successfully treated with a new cycle of the same drug and allopurinol. The diagnosis of Leishmaniasis must always be considered in immunosuppressed transplant recipients with fever and leucopenia of unknown origin, even when serology and bone marrow smear are negative.
authors.affiliation: Department of Nephrology, University Frederico II, Naples, Italy. sabbatin@unina.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Sabbatini
authors.forename: Antonio
authors.initials: A
authors.lastname: Pisani
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ragosta
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gallo
authors.forename: Francesco
authors.initials: F
authors.lastname: Borrelli
authors.forename: Bruno
authors.initials: B
authors.lastname: Cianciaruso
mesh_terms: D000328:Adult; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000209:etiology*; D008297:Male