Recurrences of Visceral Leishmaniasis Caused by Leishmania siamensis after Treatment with Amphotericin B in a Seronegative Child

Abstract

Abstract. We report the first case of visceral leishmaniasis caused by Leishmania siamensis in a seronegative child. She was treated with amphotericin B at 1 mg/kg/day for 3 weeks; however, recurrences occurred twice. The patient was cured after the administration of amphotericin B for 5 weeks and monthly prophylaxis for 6 months. CASE REPORTIn 2008, a 5-year-old girl living in a rural area of Satun Province, southern Thailand came to a provincial hospital because of abdominal enlargement for 2 months. Her condition was investigated; thalassemia and human immunodeficiency virus (HIV) infection were ruled out. After failure of diagnosis for 2 years with increased abdominal enlargement, she was referred to Songklanagarind Hospital, Prince of Songkla University, for further investigation in 2010. She was living with her parents and had no history of traveling to other areas. Her house was an untidy one-story house surrounded by trees and the rubber plantation where her parents worked as rubber tappers. Her parents had three cows and raised them nearby the house. On examination, she was an undernourished girl having good consciousness, normal vital signs, but pale, underweight by 13 kg, and had a height of 94 cm. She had abdominal distension, the liver was 2 cm below the right costal margin with soft consistency, and the spleen was 9 cm below the left costal margin. Laboratory findings showed anemia and thrombocytopenia (Hb 8.3 g/dL and Hct 27.3%, white blood cell [WBC] 6,000/μL; PMN 53%, Lymph 41%, Mono 4%, Eo 2%, and platelets 98,000/μL). Liver function test showed total bilirubin 0.6 mg/dL (normal range: 0.2-1.2 mg/dL), direct bilirubin 0.06 mg/dL (normal range: 0-0.2 mg/dL), aspartate aminotransferase (AST) 50 U/L (normal range: 0-32 U/L), alanine aminotransferase (ALT) 29 U/L (normal range: 0-33 U/L), Alkaline phosphatase 130 U/L (normal range: 167-577 U/L), Albumin 3.4 g% (normal range: 3.9-5.1 g%), globulin 7.2 g% (normal range: 2.6-3.0 g%). Coagulogram was normal. Abdominal ultrasonography revealed hepatomegaly without focal lesion and marked splenomegaly (12 + 4 cm.) without focal lesion. Liver biopsy showed portal inflammation with much mononuclear cell infiltration. Accumulation of inflammatory cells was seen in some areas of intrahepatic lobules. Amastigotes were seen in liver histiocytes. Bone marrow aspirates were positive for amastigotes of Leishmania. Serological and molecular diagnoses were performed at the

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