English

Abstract

INTRODUCTION: Visceral leishmaniasis, also known as kala-azar, is a vector borne disease caused by the protozoan parasite, L. donovani. [1] Visceral leishmaniasis is prevalent worldwide. [2] India is one of the countries that account for an estimated 300,000 of 500,000 cases of visceral leishmaniasis (VL) occurring annually. State of Bihar is the most affected area in India, with more than 90% of the cases, [3] and to some extent in its bordering states like West Bengal and Uttar Pradesh. [4] Functional derangement of liver in visceral leishmaniasis is reported infrequently in the literature, due to this, many cases are wrongly diagnosed and treated as hepatitis. [5] Common clinical manifestations are fever (99%), splenomegaly (99%), anaemia (96%), hepatomegaly (86%), distension of abdomen (47%), bleeding diathesis (14%) and pancytopenia. [6] There are case reports of visceral leishmaniasis mimicking portal hypertension, and it has been suggested that screening of the disease in children presenting with chronic liver disease is important in endemic areas. [7] Certain unusual clinical and laboratory features were seen in some of the reported cases, like lymphadenopathy, nasopharyngeal growth, acute and chronic hepatic involvement and portal hypertension. [8] One case reported from India has shown visceral leishmaniasis masquerading as chronic liver disease with abdominal doppler study revealing portal hypertension and endoscopy showing grade II oesophageal varices. [9] Sikkim is not an endemic area for kala-azar and only few sporadic cases are been reported from the state.