Delayed and Overlooked Diagnosis of an Unusual Opportunistic Infection in a Renal Transplant Recipient: Visceral Leishmaniasis

Abstract

Visceral leishmaniasis is a rare opportunistic infection in renal transplantation patients and its presentation may be associated with or masked by many other factors in immunosuppressed patients. So, if it is not searched for in particular, diagnosis may be easily overlooked or delayed in renal transplant patients. A 32-year-old renal transplant recipient devoleped splenomegaly, pyrexia and pancytopenia. Six months after the first bone marrow examination, the delayed diagnosis was made possible by a second bone marrow aspiration. Liposomal amphotericin B was effective in his treatment although he had a recurrence. Early diagnosis of visceral leishmaniasis is crucial for the renal transplant recipient's therapy; and even in treated patients, the mortality rate may be high. In our case, although the time up to diagnosis was as long as six months after the onset of symptoms, response to treatment was satisfactory with higher doses of liposomal amphotericin B in the second cycle. Also, in the short term, the rate of recurrence was comparable to other reported patients who were diagnosed and treated in a month.

High Prevalence of Asymptomatic Leishmania spp. Infection Among Liver Transplant Recipients and Donors From an Endemic Area of Brazil

“…The prevalence of asymptomatic infection in Belo Horizonte is as high as 2% . Leishmaniasis is an uncommon disease among transplant recipients, but the number of published cases has increased in recent years . More than 100 VL cases following transplantation have been reported worldwide , and 3 of the 11 cases after LT were described by our group .…”

Risk factors, clinical features and outcomes of visceral leishmaniasis in solid-organ transplant recipients: a retrospective multicenter case–control study

“…Overall, only one-third of the patients (n = 12) presented this classic triad when the diagnosis was established. Considering the high frequency of atypical VL in SOT [9,18,[21][22][23][24], disease should not be ruled out even in the absence of typical signs, particularly when the recipient or donor has traveled from an endemic zone.…”

Evaluation of Fourteen Adult Cases with Visceral Leishmaniasis

“…Diğer hastalıklara göre tanı için geçen sürenin uzun olması, viseral leyişmanyozun pek çok hastalıkla karışabil-mesi nedeniyle ayırıcı tanıda çok sayıda tetkikin yapılmasından kaynaklanabilir. Viseral leyişmanyoz kliniği uzun süren düzensiz ateş, kilo kaybı, hepatosplenomegali ve pansitopeniyle karakterizedir ve mortalitesi yüksektir 9 . Olgularımızın tümünde ateş, %57'sinde kilo kaybı, %50'sinde hepatosplenomegali, %71'inde pansitopeni ve tümünde hipoalbünemi saptanmıştır.…”

“…Çalışmamızda böbrek nakli uygulanmış bir olgumuzda dört kez viseral leyişman-yoz reaktivasyonu görülmüş ve olgu son atağında nozokomiyal enfeksiyon nedeniyle kaybedilmiştir. Bu olgumuz ayrı bir olgu raporu olarak da sunulmuştur 9 . Kaybedilen diğer hastamız ise kemik iliği nakli yapılan bir hastadır ve viseral leyişmanyoz tanısı konulduktan sonra tedaviye başlanamadan kaybedilmiştir.…”