title: Visceral leishmaniasis in a renal transplant recipient treated with allopurinol.
abstract: Leishmaniasis is an infection caused by a protozoan parasite belonging to the genus Leishmania and transmitted by the Phlebotomus sandfly. We report a case of visceral leishmaniasis in a 49-year-old male renal transplant recipient, a resident of the western part of Tunisia, which is an endemic zone for the disease. Just before and after the transplantation, the patient resided in Tunis, which is non-endemic for leishmaniasis. Visceral leishmaniasis occurred eight years after renal transplantation, and the clinical picture was characterized by fever and pancytopenia. Leishmaniae were detected by bone marrow aspiration. Pentavalent antimonal was used for 28 days and was substituted by allopurinol (20 mg/kg per day). One year after the infection, the patient remains totally asymptomatic. Our report suggests that visceral leishmaniasis may complicate the clinical course of organ transplantation and can be fatal, particularly when untreated. Relapses may occur after completion of the apparently effective treatment. Allopurinol could be a solution to avoid these relapses.
authors.affiliation: Unity of Organ Transplantation, Military Hospital, Tunis, Tunisia. harzallakais@yahoo.fr
authors.forename: Kais
authors.initials: K
authors.lastname: Harzallah
authors.forename: Raoudha
authors.initials: R
authors.lastname: Belhadj
authors.forename: Boutheina
authors.initials: B
authors.lastname: Jemli
authors.forename: Mondher
authors.initials: M
authors.lastname: Haloues
authors.forename: Naoufel
authors.initials: N
authors.lastname: Berraies
authors.forename: Saadia
authors.initials: S
authors.lastname: Gargouri
authors.forename: Jalel
authors.initials: J
authors.lastname: Hmida
authors.forename: Riadh
authors.initials: R
authors.lastname: Battikh
authors.forename: Jamel
authors.initials: J
authors.lastname: Manaa
mesh_terms: D000493:Allopurinol / Q000627:therapeutic use*; D001856:Bone Marrow Examination; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008536:Meglumine / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014344:Trypanocidal Agents / Q000627:therapeutic use*; D014416:Tunisia
chemical_list: D007166:Immunosuppressive Agents; D009942:Organometallic Compounds; D014344:Trypanocidal Agents; D000493:Allopurinol; D008536:Meglumine; D000077485:Meglumine Antimoniate