Nefro - 27-2 - MIOLO.indd

The aetiological study of cytopenia in solid organ transplant recipients could be challenging, given the need to exclude infectious disorders, drug toxicity or neoplastic disease. Visceral leishmaniasis is endemic in several regions of the world, but a rare complication after renal transplantation (less than 100 cases described in literature). We report the case of a male renal transplant recipient, 57 years of age, admitted to our Unit 17 months after transplantation with febrile illness and severe pancytopenia. He had a history of leucopenia and thrombocytopenia detected in follow-up exams two months earlier, with progressive worsening despite discontinuation of drugs with potential haematologic toxicity. On admission, his complaints were weakness, night sweats and weight loss. On examination, he was febrile, pale, and had a palpable spleen. Laboratory exams demonstrated: leukocytes 1.1 x109/L, platelets 68 x109/L, haemoglobin 10.3 g/dl, serum creatinine 1.48 mg/dl, C-reactive protein 9.72 mg/dl. Abdominal ultrasound confirmed splenomegaly. A bone marrow aspiration was performed and antibiotic therapy was instituted empirically, without improvement. Additional laboratory results were inconclusive: negative blood and urine cultures, no evidence of cytomegalovirus, parvovirus B19 or HIV infections, hepatitis B and C and masses/ adenopathies were excluded by computerized tomography. Despite the absence of an evident epidemiological context, the bone marrow examination showed amastigotes of Leishmania spp. He was started on liposomal amphotericin B (4 mg/kg/day; total of 10 administrations) with a sustained clinical and laboratory improvement after the second day of therapy. Visceral leishmaniasis is a potentially lethal infection if treatment is delayed or not instituted. Although rare among renal transplant recipients it should be included in the differential diagnosis of febrile pancytopenia. Key-Words: Kidney transplantation; liposomal amphotericin B; pancytopenia; visceral leishmaniasis Visceral leishmaniasis: an unexpected diagnosis during the evaluation of pancytopenia in a kidney transplant recipient Leishmaniose visceral: um diagnóstico inesperado na avaliação de uma pancitopenia num doente transplantado renal Pêgo C1,2, Romãozinho C1,2, Santos L1,2, Macário F1,2, Alves R1,2, Campos M1, Mota A2 1 Department of Nephrology 2 Renal Transplantation Unit and Department of Urology Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal Received for publication: 10/01/2013 Accepted in revised form: 17/05/2013 Nefro 27-2 MIOLO.indd 119 26-06-2013 15:08:44 120 Port J Nephrol Hypert 2013; 27(2): 119-123 CMYKP