title: Septic shock due to visceral leishmaniasis, probably transmitted from blood transfusion.
abstract: A case of visceral leishmaniasis (VL) in a 77-year-old woman, with renal failure on haemodialysis, admitted in the intensive care unit (ICU) with vascular instability requiring vassopressor treatment, is presented. Initially, no co-infection could be detected. The patient initially responded well when liposomal amphotericin B was administered, after bone marrow demonstrated multiple intra-cellular Leishmania amastigotes and extra-cellular promastigotes. However, the patient died from uncontrolled septic shock from a secondary bacterial infection, the tenth day of admission. To our knowledge, vascular instability has not been reported in VL. Moreover, non-vector transmission was also suspected in this case. The patient had undergone cholecystectomy three months earlier, during which two blood units had been transfused; IgG anti-Leishmania antibodies at a high titer were detected in one of the two healthy blood donors, later.
authors.affiliation: Critical Care Department, School of Medicine, University Hospital of Thessaly, Larissa, Greece.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Mpaka
authors.forename: Zoi
authors.initials: Z
authors.lastname: Daniil
authors.forename: Despina S
authors.initials: DS
authors.lastname: Kyriakou
authors.forename: Epaminondas
authors.initials: E
authors.lastname: Zakynthinos
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007891:Leishmania / Q000302:isolation & purification*; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000175:diagnosis*; D012772:Shock, Septic / Q000469:parasitology*; D065227:Transfusion Reaction
chemical_list: D000981:Antiprotozoal Agents; D000666:Amphotericin B