Diagnosis and treatment of a case with visceral leishmaniasis complicated by severe pulmonary infection

doi:10.12140/j.issn.1000-7423.2025.06.020

Abstract

Abstract:

The patient was a 38-year-old female farmer from Xiangning County, Linfen City, Shanxi Province. She was diagnosed with nephrotic syndrome in 2016 and systemic lupus erythematosus in 2021. In October 2024, the patient was admitted to the Department of Rheumatology and Immunology due to recurrent fever. Laboratory tests revealed pancytopenia, inverted albumin-globulin ratio, elevated IgG levels, coagulation abnormalities, positive anticardiolipin antibodies and splenomegaly, and sputum fungal cultures indicated Candida albicans infection. Chest CT scans on October 29 showed scattered inflammation in bilateral lungs with cavity formation in the right lower lobe. On October 31, bone marrow punctures displayed one megakaryocyte and widespread platelet distribution in blood marrow smears, and Leishmania amastigotes (Leishman-Donovan bodies) were observed across whole bone marrow smears, prompting patient’s transfer to the Department of Infectious Diseases. On November 5, serum samples were sent to Shanxi Provincial Center for Disease Control and Prevention, where the rK39 rapid immunochromatographic test yielded a positive result. On November 6, metagenomic next-generation sequencing (mNGS) of bone marrows detected 66 596 Leishmania species DNA sequences, including 1 668 L. infantum sequences with relative abundance of 52.02%. Symptomatic treatments were therefore given, including continuous oxygen therapy, transfusion of leukoreduced red blood cells, anti-infection therapy, fluid replacement, correction of hypoalbuminemia, and hemostasis. On November 4, amphotericin B cholesterol sulfate complex was administered intravenously at 50 mg via an intravenous pump, and the dose was adjusted to 100 mg on November 5 and further escalated to the 150 mg (full dose) on November 6. The patient was discharged after the discomfort symptoms gradually subsided. A follow-up examination on December 9 showed excellent antiprotozoal efficacy, with no Leishmania amastigotes detected and the pulmonary cavities disappeared. Subsequent follow-ups indicated no recurrence in the patient.

Key words: Visceral leishmaniasis, Pulmonary infection, Histoplasmosis, Amphotericin B cholesterol sulfate complex, Systemic lupus erythematosus, Metagenomic next-generation sequencing

CLC Number:

R531.6

JIN Xuan, LIU Yuanli, DENG Chunqing. Diagnosis and treatment of a case with visceral leishmaniasis complicated by severe pulmonary infection[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2025, 43(6): 874-877.

Figures/Tables 2

References 20

[1]	汪俊云, 高春花. 《黑热病诊断标准》解读[J]. 中国血吸虫病防治杂志, 2017, 29(5): 541-543.
	Wang JY, Gao CH. Interpretation of diagnostic criteria for kala-azar[J]. Chin J Schisto Control, 2017, 29(5): 541-543. (in Chinese)
[2]	魏志云, 罗小飞, 于颖洁, 等. 2019—2023年山西省黑热病流行病学特征及时空聚集性分析[J]. 预防医学情报杂志, 2025, 41(9): 1167-1171.
	Wei ZY, Luo XF, Yu YJ, et al. Epidemiological characteristics and spatio-temporal clustering of leishmaniasis in Shanxi Province from 2019 to 2023[J]. J Prev Med Inf, 2025, 41(9): 1167-1171. (in Chinese)
[3]	Georgiadou SP, Stefos A, Spanakos G, et al. Current clinical, laboratory, and treatment outcome characteristics of visceral leishmaniasis: Results from a seven-year retrospective study in Greece[J]. Int J Infect Dis, 2015, 34: 46-50.
[4]	崔银风, 张莉芸, 许珂, 等. 误诊为系统性红斑狼疮的黑热病一例[J]. 中华风湿病学杂志, 2022, 26(1): 39-41, I0002.
	Cui YF, Zhang LY, Xu K, et al. A case of kala-azar misdiagnosed as systemic lupus erythematosus[J]. Chin J Rheumatol, 2022, 26(1): 39-41, I0002. (in Chinese)
[5]	Akkuzu G, Ozkara S, Ozgur DS, et al. Visceral leishmaniasis in a patient with systemic lupus erythematosus: Dilemma in diagnosis and management[J]. Int J Rheum Dis, 2023, 26(4): 769-773.
[6]	Sheng LP, Lin BZ, Han LN, et al. Case report: Visceral leishmaniasis misdiagnosed as systemic lupus erythematosus in a 36-year-old migrant worker[J]. Front Med (Lausanne), 2025, 12: 1614790.
[7]	李杰, 李霞, 杨桂. 组织胞浆菌病误诊黑热病1例[J]. 中国寄生虫病防治杂志, 1998(4): 91.
	Li J, Li X, Yang G. Histoplasmosis misdiagnosed as kala-azar: A case report[J]. J Pathog Biol, 1998(4): 91. (in Chinese)
[8]	陈栖栖, 邬锐, 周乔, 等. 黑热病免疫学异常的临床特点分析[J]. 实用医院临床杂志, 2016, 13(3): 54-56.
	Chen XX, Wu R, Zhou Q, et al. The clinical features of immunological abnormalities of kala-azar patients[J]. Pract J Clin Med, 2016, 13(3): 54-56. (in Chinese)
[9]	谢孝泉, 蒋术侠. 以肾损害为突出表现的黑热病12例分析[J]. 临床误诊误治, 1994, 7(4): 161-162.
	Xie XQ, Jiang SX. Analysis of 12 cases of kala-azar with renal damage as the prominent manifestation[J]. Clin Misdiagnosis Mistherapy, 1994, 7(4): 161-162. (in Chinese)
[10]	Tolaj I, Mehmeti M, Gashi H, et al. Visceral leishmaniasis in Kosovo: A case of misdiagnosis and diagnostic challenges[J]. IDCases, 2023, 32: e01768.
[11]	鲁卓林, 刘力, 孙燕燕. 氯喹和羟氯喹的应用进展[J]. 国际生物医学工程杂志, 2020, 43(4): 330-334.
	Lu ZL, Liu L, Sun YY. Research progress in application of chloroquine and hydroxychloroquine[J]. Int J Biomed Eng, 2020, 43(4): 330-334. (in Chinese)
[12]	Bazmani A, Moshaverinia A, Razmi G. Simultaneous application of thymoquinone and hydroxychloroquine suppresses autophagy and disrupts the autophagosomal trench engulfed Leishmania major[J]. Iran Biomed J, 2024, 28(5 & 6): 255-264.
[13]	《中华传染病杂志》编辑委员会. 中国利什曼原虫感染诊断和治疗专家共识[J]. 中华传染病杂志, 2017, 35(9): 513-518.
	Editorial Board of the Chinese Journal of Infectious Diseases. Expert consensus on diagnosis and treatment of Leishmania infection in China[J]. Chin J Infect Dis, 2017, 35(9): 513-518. (in Chinese)
[14]	Freire ML, de Avelar DM, Pedras MJ, et al. Impact of age and immune status on the accuracy of rapid diagnostic tests for visceral leishmaniasis in Brazil[J]. PLoS Negl Trop Dis, 2025, 19(6): e0013087.
[15]	谢垒, 王瑶, 马威, 等. 宏基因组二代测序技术诊断骨髓涂片阴性婴幼儿黑热病3例报告[J]. 临床儿科杂志, 2023, 41(11): 859-862.
	Xie L, Wang Y, Ma W, et al. Diagnosis of three cases of bone marrow smear-negative infantile kala-azar by metagenomics next-generation sequencing[J]. J Clin Pediatr, 2023, 41(11): 859-862. (in Chinese)
[16]	宏基因组分析和诊断技术在急危重症感染应用专家共识组, 童朝阳, 宋振举. 宏基因组分析和诊断技术在急危重症感染应用的专家共识[J]. 中华急诊医学杂志, 2019, 28(2): 151-155.
	Expert consensus group on the application of metagenomic analysis and diagnostic techniques in critical and severe infections, Tong ZY, Song ZJ. Expert consensus on the application of metagenomic analysis and diagnosis technology in acute and critical infection[J]. Chin J Emerg Med, 2019, 28(2): 151-155. (in Chinese)
[17]	Zhao R, He GL, Xiang L, et al. Metagenomic next-generation sequencing assists in the diagnosis of visceral leishmaniasis in non-endemic areas of China[J]. Front Cell Infect Microbiol, 2025, 15: 1517046.
[18]	Zhang XG, Liu YQ, Zhang MM, et al. Case report: Diagnosis of visceral leishmaniasis using metagenomic next-generation sequencing and bone marrow smear[J]. Front Cell Infect Microbiol, 2022, 12: 1095072.
[19]	牟丽娉, 姚瑜. 解读美国传染病学会2007年修订版组织胞浆菌病临床治疗指南[J]. 国外医药(抗生素分册), 2008(3): 125-139.
	Mou LP, Yao Y. Interpretation of the revised 2007 guidelines for clinical treatment of histoplasmosis of American Society of Infectious Diseases[J]. World Notes on Antibiotics, 2008(3): 125-139. (in Chinese)
[20]	Calvopi?a M, Toro M, Bastidas-Caldes C, et al. A fatal case of disseminated histoplasmosis by Histoplasma capsulatum var. capsulatum misdiagnosed as visceral leishmaniasis-molecular diagnosis and identification[J]. Pathogens, 2023, 12(9): 1112.