Visceral leishmaniasis as a cause of postpartum pyrexia - case report

Abstract:

Introduction: Visceral leishmaniasis, caused by protozoan parasites of the Leishmania genus, is very rare cause of postpartum pyrexia.
It is also known as kala-azar, black fever, and Dumdum fever. Signs and symptoms include fever, weight loss, mucosal ulcers, fatigue,
anemia, and substantial swelling of the liver and spleen. Case report: We represent a very rare case of the septic form of visceral
leishmaniasis in a thirty-year-old woman during puerperium, 31 days after vaginal delivery. Her continuously febrile state, splenomegaly,
and laboratory findings characteristic of a febrile state meant that the disease at the beginning was understood and treated as
a puerperal sepsis. The patient’s condition worsened continuously, despite treatment with wide spectrum antimicrobial agents. Expert
advice at the Clinic decided that hysterectomy was necessary. After a short remission, her febrile state returned; we decided to transfer
the patient to the Clinic for Infectious Diseases for further evaluation and diagnosis. Microscopic analyses of a sternal biopsy showed
polymorphic forms of Leishmania chagasi, confirming the diagnosis of visceral leishmaniasis. After adequate the patient recovered
completely. Conclusion: Only careful examination, close observation, and prompt treatment performed by a multidisciplinary team of
specialists can lead to a good outcome for the patient. Bone marrow biopsy remains the gold standard in the diagnosis of Visceral
leishmaniasis.

© Versita Sp. z o.o.
Keywords: Fever of unknown origin • Postpartal period • Sepsis • Puerperium • Visceral leishmaniasis • Kala-azar

Stevan Milosevic1, Mirjana Bogavac1*, Goran Malenkovic2,
Milotka Fabri3, Maja Ruzic3, Tihomir Dugandzija4

1 University of Novi Sad, Faculty of Medicine, Clinical Center of Vojvodina - Department of Obstetrics
and Gynecology, Novi Sad, AP Vojvodina, Serbia
2 University of Novi Sad, Faculty of Medicine, Oncology Institute of Vojvodina, Clinic for Surgical Oncology -
Department of Gynecology, Sremska Kamenica, AP Vojvodina, Serbia
3 University of Novi Sad, Faculty of Medicine, Clinical Center of Vojvodina - Department for Infectious disease,
Novi Sad, AP Vojvodina, Serbia
4 University of Novi Sad, Faculty of Medicine, Oncology Institute of Vojvodina, Department of Epidemiology,
Sremska Kamenica, AP Vojvodina, Serbia

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