An Atypical Course of Visceral Leishmaniasis After Kidney Transplantation: A Case Report From Iran

Background. Organ transplantation can lead to human visceral leishmaniasis (VL) transmis-sion in humans. This report aims to describe the possible complications related to an atypical course of VL after kidney transplantation. Case Presentation. A 61-year-old man who suffered end-stage renal failure received a deceased donor kidney transplant after 2 years of hemodialysis. Tacrolimus, mycophenolate mofetil, and prednisolone were used for immunosuppressive therapy, and renal function remained stable for 2.5 years. He was referred to our hospital because of fever and malaise. Phys-ical and radiological examinations showed mild splenomegaly and cervical and inguinal lymph-adenopathy. Laboratory data showed bicytopenia, elevated C-reactive protein, serum creatinine, and non-nephrotic proteinuria. Bone marrow biopsy aspiration showed no abnormality. Polymer -ase chain reaction confirmed the diagnosis of Leishmania infantum. Anti-leishmanial therapy was initiated with liposomal amphotericin B for 2 weeks, and the patient became clinically stable. So far, there has been no evidence of clinical or biological relapse, and kidney function is stable. Conclusions. Considering that VL has become increasingly widespread in immunocompro-mised patients in endemic regions, especially in patients with transplants, it is crucial to screen and rule out VL as a cause of infection in these patients. The probability of this problem should be considered in every patient with a transplant in endemic and nonendemic areas. Furthermore, our study showed that through timely diagnosis using noninvasive methods and standard treat-ments, mortality caused by this disease can be properly prevented.