Visceral Leishmaniasis Associated with Hemophagocytic Lymphohistiocytosis

Excerpt

To the Editor: An 18-mo-old toddler hailing from Nepal presented to us with persistent fever of 4 mo duration, anemia and splenohepatomegaly. Laboratory studies demonstrated pancytopenia (hemoglobin 8.2 g/dl, TLC 3000/mm³, platelets 72,000/mm³), hypertriglyceridemia (742 mg/dl), hyperferritinemia (2075 ng/ml) with features of hemophagocytosis on bone marrow aspiration (BMA) suggesting a diagnosis of hemophagocytic lymphohistiocytosis (HLH), as it met ≥5 out of 8 of the HLH diagnostic criteria. Investigations for malaria, Epstein-Barr virus and HIV were negative. The Anti-rK39 ELISA was positive. On this basis, a diagnosis of Visceral leishmaniasis (VL) with secondary HLH was made. The patient was treated with single dose 10 mg/kg liposomal amphotericin B (LamB). Child showed clinical improvement and on follow-up after 8 wk there was no fever, spleen size had significantly decreased and blood counts had normalized. …