Visceral leishmaniasis in a patient with cutaneous lesions, negative Leishman-Donovan bodies and immunological test: A case report

We report a case of visceral leishmaniasis (VL) in a patient from Shush in Iran with cutaneous lesions, negative for Leishman-Donovan bodies, enlarged spleen filled by leishmania protozoa and negative immunological test. The patient was a 26-year-old male, who attended hospital with fever and two deep purulent lesions on the distal part of his left leg. On physical examination, the patient had splenomegaly. Laboratory results were as follows: pancytopenia, positive C-reactive protein (CRP), elevated erythrocyte sedimentation rate (ESR) and lactate dehydrogenase (LDH) levels. Indirect fluorescent antibody (IFA) screening for leishmaniasis was negative. Smear of wound discharge were negative for Leishman bodies. The necessary treatment was started for patient. Diagnostic splenectomy was performed, which pathological exploration showed a bulk of leishmania protozoa in his spleen. Twenty days later, this patient expired.