A Challenging Case of Visceral Leishmaniasis in a Transplant Recipient

Visceral leishmaniasis is a rare disease in Western countries. We present the case of a 72-year-old male recipient of a related live donor renal transplant 41 years earlier and a past medical history of visceral leishmaniasis, who presented with progressive malaise, diarrhea, weight loss and darkening of skin, 11 months after the first episode. The main finding on blood work was severe hyponatremia and pancytopenia. He was diagnosed with relapsing visceral leishmaniasis and treated with liposomal amphotericin B (L-AmB), reduction of immunosuppressive therapy and supportive therapy. Throughout treatment he had worsening bradycardia and hyponatremia accompanied with liver failure and acute congestive heart failure. The patient survived the leishmaniasis episode but had sequels of chronic liver disease and chronic heart failure. The authors report the case due to its clinical challenge and due to the fact that data on how to treat immunodeficient patients with relapsing leishmaniasis is scarce.