[From unexplained fever to visceral leishmaniasis--a case report].
Visceral leishmaniasis or kala-azar is a systemic infectious vector-borne disease caused by protozoa Leishmania donovani and Leishmania infantum that are transmitted to mammalian hosts by sand flies. It occurrs sporadically in endemic areas, including Mediterranean basin. Southern coastal territories of Croatia have been recognized as the foci of the disease. Dogs are the main reservoir of human infection. Clinical features include prolonged fever, malaise, hepatosplenomegaly, pancytopenia and inversion of albumin-globulin ratio. If left untreated, the disease causes death in majority of cases. We report a 47-year-old Croatian patient who was admitted to hospital with 2-month history of fever of unknown origin. Based on bone marrow aspirate findings and positive serological tests, the diagnosis of visceral leishmaniasis was established. We also considered secondary hemophagocytic lymphohystiocytosis in the differential diagnosis. After a 4-week treatment with sodium-stibogluconate clinical remission was achieved as well as complete recovery of hematopoesis. The aim of our case-report is to stress the importance of considering visceral leishmaniasis in patients with longstanding fever in endemic areas.
Ivan
I
Marković
Ana
A
Gudelj-Gracanin
Melanie-Ivana
MI
Culo
Tajana
T
Stoos-Veić
Ninoslava
N
Vicković
Bosko
B
Desnica
Jadranka
J
Morović-Vergles
D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001853:Bone Marrow / Q000469:parasitology; D017523:Croatia; D003937:Diagnosis, Differential; D004285:Dogs; D005335:Fever of Unknown Origin / Q000469:parasitology*; D006801:Humans; D018314:Leishmania infantum / Q000302:isolation & purification; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000981:Antiprotozoal Agents