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Visceral leishmaniasis with haemophagocytic lymphohistiocytosis
  1. John Titus George1,
  2. Mohammad Sadiq1,
  3. Elanthenral Sigamani2 and
  4. Alice Joan Mathuram1
  1. 1 Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  2. 2 Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  1. Correspondence to Dr John Titus George, johntgeorg{at}


A 27-year-old man presented with high-grade intermittent fever for 4 months, generalised fatigue for 2 months, intermittent gum bleeds for 1 month and loss of weight of 15 kg. He appeared cachectic with generalised wasting, had pallor and features of reticuloendothelial system proliferation. His liver span was 17 cm. He had massive splenomegaly. His cardiovascular, respiratory and neurological examination were normal. He was diagnosed to have visceral leishmaniasis (VL) based on bone marrow (BM) examination that showed Leishmania donovani (LD) bodies and was treated with liposomal amphotericin (LA). During the course of therapy, he developed bleeding from various mucosal and venepuncture sites. His further evaluation, which included a repeat BM aspirate, showed haemophagocytes. Final diagnosis made was VL with secondary haemophagocytic lymphohistiocytosis. He was continued on LA with intravenous hydrocortisone. He developed refractory distributive shock with multiorgan dysfunction and succumbed to his illness.

  • tropical medicine (infectious disease)
  • medical management
  • immunology

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  • Contributors JTG and MS were involved in the primary evaluation and management of the patient, conception and drafting of the case report. AJM and MS were involved in reviewing existing literature and revising the report. ES was involved in providing the final histopathological diagnosis and revising the report. JTG is a guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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