Title : A case of Visceral Leishmaniasis in a non-endemic region
Abstract:
Leishmaniasis is a tropical parasitic infection transmitted by sand flies. It is sporadically seen in the Aegean, Mediterranean and Central Anatolia regions of Turkey. Here, we wanted to present a non-endemic case of visceral leishmaniasis. A 5-year-old girl was admitted to the hospital with abdominal distension and fever for 1 month. She had membranous tonsillitis on physical examination. The liver was 3 cm and the spleen was 7 cm. Laboratory tests showed pancytopenia. There were no blasts or atypical cells in the peripheral smear, and lymphocytes predominated. Ultrasonography showed hepatomegaly, massive splenomegaly and splenic vein dilatation. She had no fever during follow-up, but her neutropenia deepened. Parvovirus IgM was negative, EBV VCA IgM and IgG were positive. However, since the patient's cytopenia did not improve and splenomegaly remained the same, bone marrow aspiration was performed. Hemophagocytosis and leishmania amastigotes were seen in bone marrow smear. Leishmania PCR and serology were positive. There was no history of travel to endemic areas. The patient, whose general condition was good, was given ambizome 3 mg/kg/dose for 7 days. Splenomegaly regressed by 3 cm on the 4th day of treatment. Hemogram improved on the last day of treatment. Regression was observed in splenic vein and splenomegaly. The patient did not have hepatosplenomegaly at the 1st month follow-up. Although Kocaeli is not endemic for visceral leishmaniasis, it has been observed sporadically in recent years, with a few cases per year. Global warming and the increase in reservoirs may also be factors in this. In this case, EBV serology positivity could have caused the case to go unnoticed. However, the persistent pancytopenia and the presence of massive splenomegaly directed us to bone marrow aspiration. In conclusion, visceral leishmaniasis should be kept in mind in the presence of persistent pancytopenia and massive splenomegaly even in non-endemic areas.
