P13 | A case of visceral leishmaniasis in a young man

Background: Visceral leishmaniasis is a disseminated protozoan infection caused by Leishmania donovani, which transmission occurs via the bite of sand flies. It is worldwide distributed with highest prevalence in India, Africa and Mediterranean countries. Main clinical features (fever, hepatosplenomegaly, pancytopenia) are common to several diseases. It is emergeing as opportunistic infection in HIV patients for whom the course tends to be more severe.Case report: A 40 years old Nigerian man presented fever and abdominal pain worsening in 2 weeks. He had malarian fever as a child, he didn’t use drugs or alcohol and receive blood transfusions in the past; physical examination revealed enlarged spleen (14 x 6 cm) and liver confirmed by echography. Blood tests showed pancytopenia (Hb 8.8 g/dl, MCV 82 fL, WBC 2560/mcL, N 880, PLTs 131/mcL) high transaminases (GOT 70 UI/ml, GPT 140 UI/ml) and acute phase proteins (PCR 20 mg/dL, ferritin 10.000 ng/ml), polyclonal hypergammaglobulinemia, normal iron status (TSAT 22%). CT chest scan was normal. Urine and blood cultures, hepatotropic virus screening and blood PCR for Malaria and Leishmania were negative. Suspicious of Visceral leishmaniasis was confirmed by detection of amastigotes in the bone marrow. The patient was treated with intravenous liposomal amphotericin B and recovered.Conclusions: Visceral leishmaniasis is almost fatal without treatment. It must be promptly considered in differential diagnoses of people coming from endemic areas. HIV coinfection should be ruled out because of the increased risk of death.