Visceral Leishmaniasis with renal involvement or Systemic lupus Erythematosus: Clinicians dilemma

Abstract

Indian subcontinent is responsible for the largest proportion of global Visceral Leishmaniasis. 35 year old man watchman by occupation hailing from Nepal came with complaints of high grade fever on and off since two months. He also had pedal oedema, breathlessness, oliguria and distension of abdomen. On examination patient had pallor, pedal oedema, ascites and splenomegaly. His investigations showed proeteinuria (1.5 gm/day), raised Creatinine and pancytopenia. Bone marrow aspiration showed multiple Leishmania Donovani(LD) bodies, amastigote form scattered intracellular/extracellular form. Bone marrow Biopsy was suggestive of normocellular marrow with histiocytic infiltration with LD bodies. Patient was treated with Amphotericin B infusions. Patients condition deteriorated due to amphotericin induced nephrotoxicity. Report of ANA +2 (1:160) nucleolar was then received. Patient was given methyl prednisolone injection 1 gm /day for 5 days. Patient succumbed to hypo-proteinemia, sepsis and renal impairment. Visceral Leishmaniasis and Systemic Lupus Erythematosus (SLE) with flare both can mimic each other due to overlapping clinical features.SLE can have simultaneous infection with VL in endemic areas. A clinician will have to use is detailed history, thorough examination, battery of laboratory investigations and his clinical acumen to arrive at diagnosis and rule out the mimicker.