Combination therapy success in refractory pediatric visceral leishmaniasis with hemophagocytic lymphohistiocytosis: A case report

Rationale: Visceral leishmaniasis (VL) is a parasitic disease with high mortality if untreated. Its association with secondary hemophagocytic lymphohistiocytosis (HLH) is rare but life-threatening, posing diagnostic and therapeutic challenges. Patient concerns: An 11-month-old female presented with fever, abdominal distension, and pancytopenia. Diagnoses: Bone marrow examination confirmed VL, and laboratory findings indicated secondary HLH. Interventions: Initial treatment with sodium stibogluconate and liposomal amphotericin B was unsuccessful. Following a multidisciplinary review, miltefosine was initiated alongside repeat doses of liposomal amphotericin B. Outcomes: The combination therapy resulted in rapid clinical and hematologic improvement. Lessons: This case highlights the importance of early recognition of HLH in VL, the role of multidisciplinary management, and the potential efficacy of combination therapy in refractory pediatric cases, particularly in resource-limited settings.