Dual Complication of Visceral Leishmaniasis-Hemophagocytic Lymphohistiocytosis and Myocarditis–A Case Report

Eyosias Lemma Teshome, Henok Baharu Wedajeneh, Tigist Desta Beyene and Temesgen Assefa Ayele*

Visceral Leishmaniosis is a life-threatening protozoal disease that can affect multiple organs. It typically presents with fever, hepatosplenomegaly, and cytopenia, but can sometimes manifest with rare complications. This case report discusses a 20-year-old male who presented with intermittent low-grade fever, night sweats, loss of appetite, vomiting of ingested matter, and a 6 kg weight loss for the past three months. He was acutely and chronically ill with a blood pressure of 80/50 mmHg, a heart rate of 120 beats per minute, a respiratory rate of 28 breaths per minute, and a temperature ranging from 38.3°C to 39.0°C. He had mild pleural effusion and hepatomegaly with liver extending 6 cm below the right costal margin and splenomegaly, with the spleen palpable 4 cm below the left costal margin. The patient also exhibited pedal edema. Initial investigation showed pancytopenia (WBC: 980, Hemoglobin/Hematocrit: 7 and 18.9, and platelets of 80000). He was managed as a case of sepsis of the chest and Gastrointestinal focus for eight days with broad-spectrum antibiotics. He was transfused several times, and his hemoglobin was starting to rise until he developed type I respiratory failure secondary to cardiogenic shock with pulmonary edema secondary to acute myocarditis. For this, he was managed at the ICU with vasopressor and diuresis, and when the cell count further dropped, bone marrow aspiration was done, which suggested secondary Hemophagocytic Lymphohistiocytosis. Other additional serologic tests confirmed the diagnosis (RK39 was positive, Serum Triglyceride was 418, and Serum Ferritin was 1500). The patient was treated according to the 2004 HLH protocol and discharged improved. This complication of leishmaniosis is due to immune system hyperactivation in response to the protozoa in the bone marrow. Additionally, the cardiovascular symptoms can be possibly due to the direct involvement of the protozoa in the heart, which is usually managed supportively. Both conditions are uncommon, and this report highlights the importance of maintaining a high level of suspicion for these complications and initiating early treatment. 

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Published on: May 19, 2026 Pages: 1-5

Full Text PDF Full Text HTML DOI: 10.17352/ahcrr.000052
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