From Pancytopenia to Diagnosis: Visceral Leishmaniasis Identified Through Primary Care Assessment

TL;DR

A case of visceral leishmaniasis in a healthy young adult was diagnosed through primary care assessment and confirmed in secondary care.

Contribution

This case emphasizes the importance of primary care vigilance in diagnosing rare diseases like visceral leishmaniasis in non-endemic regions.

Findings

Pancytopenia and fever led to the diagnosis of visceral leishmaniasis in a previously healthy patient.

Bone marrow aspirate confirmed the presence of Leishmania amastigotes.

Treatment with liposomal amphotericin B resulted in full recovery.

Abstract

Visceral leishmaniasis is a potentially life-threatening systemic parasitic infection caused by protozoa of the genus Leishmania and transmitted by sandflies. Although uncommon in Portugal, it should be considered in the differential diagnosis of prolonged fever associated with pancytopenia and hepatosplenomegaly, even in immunocompetent individuals. We report a case of a previously healthy young adult who initially presented to an urgent Family Medicine consultation in primary care, where pancytopenia was identified and prompted timely referral to secondary care. Diagnosis was confirmed by the detection of Leishmania amastigotes in bone marrow aspirate during haematological investigation. Treatment with liposomal amphotericin B resulted in complete clinical and laboratory recovery. This case highlights the importance of careful primary care assessment, recognition of red flags, and effective coordination between primary and secondary care in non-endemic settings.

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