Recurrent American visceral leishmaniasis in a kidney transplant recipient: A case report

Abstract

Introduction: American visceral leishmaniasis (AVL) is a neglected tropical disease that causes severe conditions in immunosuppressed patients such as kidney transplant recipients. In these individuals, the infection can be associated with renal graft dysfunction and loss.

Objective: To describe the case of a female kidney transplant recipient assisted at the Clinical Hospital of the School of Medicine of Merilia, who died probably as a result of hemodialysis-related complications after graft loss due to treatment toxicity of her underlying disease.

Clinical case: A 22-year-old patient, resident in an endemic region of AVL, immunosuppressed due to renal transplantation, who evolved to graft loss after successive relapses, treatment and drug prophylaxis for AVL. With the interruption of immunosuppressive therapy and return to dialysis, amastigote forms were not observed in a bone marrow aspirate smears. However, after one year, she progressed to death due to a cerebrovascular accident resulting from comorbidities.

Conclusions: It is described a rare case of successive relapses of AVL and difficult medical decision due to the therapeutic impasse between the use of immunosuppressive drugs for renal graft maintenance and treatment for the parasitic disease. The parasitological control was observed with the immunosuppression suspension, demonstrating the importance of a competent immune system and the adjuvant of specific drugs for the control of the disease.