Published online May 25, 2013. doi: 10.5495/wjcid.v3.i2.20
Revised: April 19, 2013
Accepted: April 28, 2013
Published online: May 25, 2013
Visceral leishmaniasis (VL) or kala-azar is a zoonosis caused by intracellular protozoa of the Leishmania genus and is transmitted to humans by the bite of phlebotomine sandflies. It particularly affects cells in the phagocytic mononuclear system, accompanied by disturbances of cellular and humoral immunity. VL is potentially fatal and is characterized by fever, hepatosplenomegaly, diarrhea, epistaxis, jaundice, anemia, leucopenia, thrombocytopenia, hypoalbuminemia and hyperglobulinemia. Diagnostic suspicion is based on epidemiological, clinical and laboratory data and is confirmed by detecting the parasite in infected tissue. Splenic aspiration is the most sensitive method, followed by bone marrow aspiration (BMA) by sternal puncture, liver biopsy and lymph node aspiration; but, due to safety concerns, BMA is the most recommended method. VL is included as a target disease by players in drug research and development. Severe liver dysfunction associated with VL is uncommon. We report two VL cases in pregnant women from Bauru, Sao Paulo state, Brazil, considered an endemic area. The first of them developed hepatic failure due to fulminant hepatitis. In both cases, BMA was unable to find the protozoan; thus, liver biopsy was the only means of making the diagnosis.
Core tip: Visceral leishmaniasis, which has many severe presentations, is an endemic disease found in many countries around the world, especially in South America, where Brazil is the most affected country. We herein present two cases of this disease affecting women during pregnancy, when the diagnosis and management can be very difficult. In both patients, the usual method of diagnosis failed so liver biopsy was the only option to make the correct diagnosis. Therefore, liver biopsy may be considered in special situations when severe visceral leishmaniasis is suspected, as in the cases herein presented.