Visceral Leishmaniasis with Endobronchial Involvement in an Immunocompetent Adult

Abstract

Visceral leishmaniasis is characterized by fever, cachexia, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Cough may be a presenting symptom as well. However, pulmonary involvement is considered rare and mainly described in immunocompromised patients. We describe a case of an immunocompetent adult whose clinical presentation was dominated by cough and hemoptysis. Bronchoscopy revealed a discreet polypoid mucosal endobronchial lesion whose biopsy yielded Leishmania amastigotes within histiocytes. Transbronchial needle biopsy of a right paratracheal lymph node was also positive. Leishmania amastigotes were also found on bone marrow and liver biopsies. Treatment with IV Amphotericin B was successful. In conclusion, cough should not be overlooked as a presenting symptom of visceral leishmaniasis and may be a sign of pulmonary involvement.

Bronchoscopy and Lung Fine-Needle Aspiration for Antemortem Evaluation of Pulmonary Involvement in Dogs with Naturally Occurring Canine Leishmaniosis

“…Clinical signs originating from the lower respiratory tract are considered rare in VL cases. Nevertheless, dry cough was noted in 16% and 25.9% of the cases in two retrospective studies [ 24 , 25 ], and in separate case reports [ 26 , 27 , 28 , 29 ]. Bronchial mucosa involvement has been described in immunocompetent [ 26 , 30 ], immunocompromised [ 28 , 29 , 31 ], and bronchial asthma patients [ 32 ].…”

A Very Unusual Cause of Persistent Cough Diagnosed by Bronchoscopy

“…Although Piens et al [9] and Kotsifas et al [10] have shown that there are very few reports of tracheobronchial mucosal lesions due to Leishmania , we consider it interesting to note that, despite the immune suppression found in our patient, only the bronchial mucosa was seen to be affected with no other organ involvement (negative bone marrow study). This underscores the relevant and exceptional nature of our case.…”

Utility of chest imaging in the diagnosis and management of patients with visceral leishmaniasis: A systematic review

“…65 Diagnosis of VL can be made based on demonstration of the parasite in pleural fluid, 35,40 BAL fluid, 47 transbronchial or open lung biopsy, 39,42,45 pleural biopsy 45 mediastinal lymph node biopsy, 36,43,45 pericardial fluid 46 tracheal, or bronchial biopsy. 43,49 PCR on respiratory samples has also been used to diagnose leishmaniasis with increased sensitivity. 40,44 Patients with lung involvement, lung biopsy, and BAL fluid have a better diagnostic yield for amastigotes than pleural fluid.…”

“…Immune dysregulation associated with VL may predispose patients to develop pulmonary infections. 43 , 52 However, respiratory symptoms should be considered signs of lung involvement in both immunocompetent and immunocompromised patients. 38 , 39 , 43 , 45 In addition, patients with no respiratory symptoms may still have abnormalities on chest imaging, and the parasite can be detected.…”

“…Most of the included studies were case reports and one study followed a cross-sectional design. [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] The majority of the studies came from India, southern European countries, and Brazil. The studies included 59 patients with a mean age (standard deviation) of 40.3 (±5.9) years, with males predominating (74.5%; 44) and 20% (12) patients co-infected with HIV/AIDS and immunocompromised.…”