Visceral leishmaniasis: amastigotes in the bone marrow

A 50-year-old man came to the emergency room of a university hospital complaining of weight loss, fever and abdominal pain associated with hepatosplenomegaly. Laboratory investigations revealed pancytopenia with red blood cell (RBC) count of 2.35 × 10¹²/L, hemoglobin 7.2 g/dL (RBCs with rouleaux formation), platelets of 75.7 × 10⁹/L, white blood cell count of 2.77 × 10⁹/L (with 58% neutrophils, 27% lymphocytes, 15% monocytes, 0% eosinophils and 0% basophils), hypoalbuminemia (1.31 g/dL) and hypergammaglobulinemia (6.63 g/dL). Serological test results were negative for antibodies for hepatitis (B and C) and human immunodeficiency virus (HIV). Due to the laboratory findings and sustained pancytopenia, a bone marrow biopsy was performed which showed Leishmania amastigotes phagocytosed by macrophages (Figure 1) confirming the diagnosis of visceral leishmaniasis infection.^1,2

Figure 1
Leishmania amastigotes phagocytosed by macrophages. Black arrows show amastigotes (May - Grünwald stain; (A) magnification: 400×, (B) magnification: 1000×).

References

• ¹
  Pagliano P, Esposito S. Visceral leishmaosis in immunocompromised host: an update and literature review. J Chemother. 2017;29(5):261-6.
• ²
  Koster KL, Laws HJ, Troeger A, Meisel R, Borkhardt A, Oommen PT. Visceral leishmaniasis as a possible reason for pancytopenia. Front Pediatr. 2015;29(3):59.

Publication Dates

• Publication in this collection
  15 Apr 2019
• Date of issue
  Jan-Mar 2019

History

• Received
  12 Dec 2017
• Accepted
  20 June 2018