[Pancytopenia, fever, and splenomegaly in a 2-year-old boy].
METHODS
Suspected of having a systemic malignancy a 22-month-old boy was admitted to hospital with fever, pancytopenia and hepatosplenomegaly. The boy was of ethnically German origin and no travel abroad was reported.


METHODS
Intensive search for a focus of infection, laboratory tests and bone marrow microscopy failed to be diagnostic. Serological findings and detection of Leishmania DNA in bone marrow by polymerase chain reaction (PCR) led to the diagnosis of visceral leishmaniasis. On explicit questioning the child's parents reported a stay in Greece 18 months before onset of symptoms.


METHODS
On the fourth day of i.v. therapy with liposomal amphotericin B, 3mg/kg/d for 10 days, the fever subsided. Platelets and leukocytes regained normal levels. The child was discharged after 10 days of treatment and received two more doses on days 14 and 21.


CONCLUSIONS
Negative results on microscopic bone marrow inspection do not rule out visceral leishmaniasis. Detection of anti-Leishmania antibodies may support the suspected diagnosis and provide the indication for PCR technique.
Schmid
M B
MB
Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Ulm. manuel_schmid@gmx.de
Leichsenring
M
M
Keller
C
C
Hegasy
G
G
D000666:Amphotericin B / Q000008:administration & dosage*; D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood; D000981:Antiprotozoal Agents / Q000008:administration & dosage*; D001853:Bone Marrow / Q000469:parasitology; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000032:analysis; D003937:Diagnosis, Differential; D005334:Fever; D006115:Greece; D006801:Humans; D007891:Leishmania / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy; D008081:Liposomes; D008297:Male; D010198:Pancytopenia; D016133:Polymerase Chain Reaction; D013163:Splenomegaly; D014195:Travel
D000913:Antibodies, Protozoan; D000981:Antiprotozoal Agents; D016054:DNA, Protozoan; D008081:Liposomes; D000666:Amphotericin B