23. Case study: Visceral leishmaniasis - A rare cause of hepatosplenomegaly in australia

Abstract

<h3>Background</h3> Although still endemic in Africa, South America, Southern Europe and South Asia, leishmaniasis is seldom seen in Australia, and as a result clinicians often have a low index of suspicion for this disease. <h3>Case</h3> A 48-year-old male presented with fevers, shortness of breath, weight loss, anaemia and lymphadenopathy. He had no significant past medical history, and denied any recent overseas travel. On admission he was noted to be mildly tachypnoiec and febrile, and his blood tests showed pancytopenia and mild kidney injury. He initially had an excisional inguinal lymph node biopsy which showed reactive changes only. Imaging demonstrated massive hepatosplenomegaly, and PET scan showed abnormal uptake in the spleen. Bone marrow aspirate and trephine were unhelpful, showing reactive changes only. He proceeded to splenectomy, where histopathology demonstrated numerous amastigotes, and the diagnosis of visceral leishmaniasis (presumed to be leishmaniasis chagasi/infantum, which will be subsequently confirmed with PCR± serology). Treatment was commenced with liposomal amphotericin B, and the patient was shortly thereafter discharged from hospital for further outpatient treatment. <h3>Discussion</h3> This case illustrates the need to always consider visceral leishmaniasis in the differential diagnoses of unexplained hepatosplenomegaly, even in parts of the world where the disease is not endemic, and without relevant travel history to endemic areas. Although this is always likely to be a difficult diagnosis, a higher index of suspicion may have prompted more expeditious investigation and treatment. This is an important consideration given the high morbidity/mortality of untreated or misdiagnosed cases of visceral leishmaniasis.