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Visceral Leishmaniasis presenting with intestinal failure: a case report and literature review

2008; Lippincott Williams & Wilkins; Volume: 21; Issue: 1 Linguagem: Inglês

10.1097/meg.0b013e32830e6fdb

1473-5687

Lucy Hicks, Prashant Kant, Poi Hoon Tay, Veronica Vincini, H.‐U. SCHUSTER, Olorunda Rotimi, Nicola Maughan, Christopher Jordan, Stephen E. Moss, Simon Everett, P. J. Hamlin,

Trypanosoma species research and implications

We describe an unusual case of visceral Leishmaniasis affecting the gastrointestinal tract in a young immunocompetent patient whose only recent foreign travel was a trip to Mexico 9 months previously. She presented insidiously with diarrhoea, weight loss and developed subacute intestinal failure. Interestingly, she lacked most of the typical features of acute infection, including visceromegaly, fevers and hypergammaglobulinaemia. Atypical visceral involvement involving the gastrointestinal tract is well recognized in HIV coinfection, but very rare in immunocompetent patients. Repeated microscopy and culture of endoscopic biopsies failed to identify Leishmania parasites. Serological tests – direct agglutination test and anti-K39 antibody tests – were negative. This case highlights a very rare presentation of the condition with the absence of other visceral involvement and diagnosis being eventually made solely on polymerase chain reaction of rectal tissue, with a subsequent excellent response to therapy with intravenous liposomal amphotericin.