title: Visceral Leishmaniasis presenting with intestinal failure: a case report and literature review.
abstract: We describe an unusual case of visceral Leishmaniasis affecting the gastrointestinal tract in a young immunocompetent patient whose only recent foreign travel was a trip to Mexico 9 months previously. She presented insidiously with diarrhoea, weight loss and developed subacute intestinal failure. Interestingly, she lacked most of the typical features of acute infection, including visceromegaly, fevers and hypergammaglobulinaemia. Atypical visceral involvement involving the gastrointestinal tract is well recognized in HIV coinfection, but very rare in immunocompetent patients. Repeated microscopy and culture of endoscopic biopsies failed to identify Leishmania parasites. Serological tests - direct agglutination test and anti-K39 antibody tests - were negative. This case highlights a very rare presentation of the condition with the absence of other visceral involvement and diagnosis being eventually made solely on polymerase chain reaction of rectal tissue, with a subsequent excellent response to therapy with intravenous liposomal amphotericin.
authors.affiliation: Department of Gastroenterology, Leeds General Infirmary, Leeds, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Hicks
authors.forename: Prashant
authors.initials: P
authors.lastname: Kant
authors.forename: Poi Hoon
authors.initials: PH
authors.lastname: Tay
authors.forename: Veronica
authors.initials: V
authors.lastname: Vincini
authors.forename: Helmut
authors.initials: H
authors.lastname: Schuster
authors.forename: Olorunda
authors.initials: O
authors.lastname: Rotimi
authors.forename: Nicola
authors.initials: N
authors.lastname: Maughan
authors.forename: Christopher
authors.initials: C
authors.lastname: Jordan
authors.forename: Stephen
authors.initials: S
authors.lastname: Moss
authors.forename: Simon
authors.initials: S
authors.lastname: Everett
authors.forename: Peter John
authors.initials: PJ
authors.lastname: Hamlin
mesh_terms: D000328:Adult; D003108:Colonic Diseases / Q000175:diagnosis* / Q000469:parasitology; D005260:Female; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000175:diagnosis*; D007898:Leishmaniasis, Visceral / Q000175:diagnosis*; D016133:Polymerase Chain Reaction; D012002:Rectal Diseases / Q000175:diagnosis* / Q000469:parasitology