Visceral leishmaniasis – from a case-report with retinal haemorrhages

Abstract

Visceral Leishmaniasis (VL) is a worldwide infection including
multiple clinical syndromes, increasingly recognized as an opportunistic infection, associated with immunosuppression conditions,
particularly HIV infection. Fever, constitutional symptoms, splenomegaly and pancytopenia are the most characteristic features.
Ocular involvement with intra-retinal haemorrhage is very rare.
Diagnosis can be difficult as parasite identification is not always
possible, serological tests have suboptimal sensitivity, and molecular biology techniques, like Polymerase Chain Reaction, are
often unavailable in clinical practice.
Except in India, antimonial drugs have been first choice therapy,
although there is a trend towards Amphotericin in immunocompromised patients.
In this case-report we present a 35-years-old patient, resident
in an endemic area of the disease, HIV-seronegative, with a longstanding condition of constitutional symptoms, fever, massive
splenomegaly and pancytopenia. Attempts to isolate the parasite
were of no avail; there was no evidence of another disease,
and serological tests results for Leishmania were positive and
strongly suggestive of active infection. Just before beginning
antimony treatment, the patient mentioned blurred vision and
an ophthalmologic examination showed bilateral retinal haemorrhages. Full ocular and clinic laboratorial recovery ensued along
the treatment course.
We report this case due to the unusual ocular lesions in VL
and complexity issues concerning the diagnosis. With this paper
we also want to remind that, in spite of its rarity in developed
countries, VL should not be underestimated in a patient with a
suggestive clinical condition.