Visceral leishmaniasis as a cause of postpartum pyrexia - Case report

Abstract

Introduction: Visceral leishmaniasis, caused by protozoan parasites of the Leishmania genus, is very rare cause of postpartum pyrexia. It is also known as kala-azar, black fever, and Dumdum fever. Signs and symptoms include fever, weight loss, mucosal ulcers, fatigue, anemia, and substantial swelling of the liver and spleen. Case report: We represent a very rare case of the septic form of visceral leishmaniasis in a thirty-year-old woman during puerperium, 31 days after vaginal delivery. Her continuously febrile state, splenomegaly, and laboratory findings characteristic of a febrile state meant that the disease at the beginning was understood and treated as a puerperal sepsis. The patient's condition worsened continuously, despite treatment with wide spectrum antimicrobial agents. Expert advice at the Clinic decided that hysterectomy was necessary. After a short remission, her febrile state returned; we decided to transfer the patient to the Clinic for Infectious Diseases for further evaluation and diagnosis. Microscopic analyses of a sternal biopsy showed polymorphic forms of Leishmania chagasi, confirming the diagnosis of visceral leishmaniasis. After adequate the patient recovered completely. Conclusion: Only careful examination, close observation, and prompt treatment performed by a multidisciplinary team of specialists can lead to a good outcome for the patient. Bone marrow biopsy remains the gold standard in the diagnosis of Visceral leishmaniasis. © 2013 Versita Warsaw and Springer-Verlag Berlin Heidelberg.