A rare case of visceral Leishmaniasis and CoViD-19 co-infection. Misdiagnosis in the CoViD era

ABSTRACT

Background: CoViD-19 is a global pandemic, with high mortality and morbidity. Leishmaniases are protozoan diseases transmitted by phlebotomine sand flies, with increasing incidence worldwide. In the CoViD-19 pandemic era the focus was on the coronavirus infection but similarities in the febrile course and other manifestations of some diseases may lead to clinical misdiagnosis and can lead to patient harm from delay in the correct treatment. Description of the case We describe a case of a 28-year-old patient who was hospitalized for SARS-CoV-2 pneumonia. He presented a mild fever (37.7°), progressive weakness and headache. PCR test for CoViD-19 was positive, and there was ground glass opacities in the lower left lobe of the lung on computed tomography scan. On physical examination, patient was febrile and hepatosplenomegaly was note. Laboratory investigation demonstrated pancytopenia with hemoglobin -8.9 g/dl, RBC 2.58 × 106/μl, WBC 1 × 103/μl, platelet count 63 × 103/μl. A diagnosis of visceral leishmaniasis (kala-azar) was made based on the bone marrow aspiration cytology. The patient was treated by intravenous administration of amphotericine B, he responded favorably to treatment. Conclusions: This case demonstrated that the diagnosis and management of other infectious diseases can be challenging in times of this pandemic. The vigilance for timely diagnosis needed for patients suspected of having CoViD-19 is imperative but it should not deter us from recognizing possible differential diagnoses.