title: Concurrent cutaneous, visceral and ocular leishmaniasis caused by Leishmania (Viannia) braziliensis in a kidney transplant patient.
abstract: Although cases of leishmaniasis co-infection have been described in acquired immunodeficiency syndrome patients as well as those who have undergone organ transplants, to our knowledge, the present report is the first documented case of simultaneous cutaneous, visceral and ocular leishmaniasis due to Leishmania (Viannia) braziliensis in a transplant patient. The patient had been using immunosuppressive drugs since receiving a transplanted kidney. The first clinical signs of leishmaniasis included fever, thoracic pain, hepatosplenomegaly, leucopenia and anemia. The cutaneous disease was revealed by the presence of amastigotes in the skin biopsy. After three months, the patient presented fever with conjunctive hyperemia, intense ocular pain and low visual acuity. Parasites isolated from iliac crest, aqueous humor and vitreous body were examined using a range of molecular techniques. The same strain of L. (V.) braziliensis was responsible for the different clinical manifestations. The immunosuppressive drugs probably contributed to the dissemination of Leishmania.
authors.affiliation: Laboratório de Leishmanioses, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, MG, 30190-002, Brasil. gontijo@cpqrr.fiocruz.br
authors.forename: Célia M F
authors.initials: CM
authors.lastname: Gontijo
authors.forename: Raquel S
authors.initials: RS
authors.lastname: Pacheco
authors.forename: Fernando
authors.initials: F
authors.lastname: Orefice
authors.forename: Euler
authors.initials: E
authors.lastname: Lasmar
authors.forename: Eduardo S
authors.initials: ES
authors.lastname: Silva
authors.forename: Maria Norma
authors.initials: MN
authors.lastname: Melo
mesh_terms: D000328:Adult; D000818:Animals; D015822:Eye Infections, Parasitic / Q000175:diagnosis / Q000469:parasitology*; D017809:Fatal Outcome; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D016030:Kidney Transplantation; D007892:Leishmania braziliensis; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis / Q000469:parasitology*; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000469:parasitology*; D008297:Male