Main Article Content
Aims: The aim of the paper is to acknowledge the atypical presentation of Visceral Leishmaniasis (VL) and subsequently tailor the management based on the patient’s characteristics and clinical context, while comparing it to standard practice.
Case Presentation: We report a case of VL in a nine-year old Bahraini girl, presenting with a painful breast cyst. Ultrasound guided fine need aspiration of the cysts revealed the leishmania amastigotes. The patient was treated with complete cyst aspiration and received no further treatment. The patient did well, with no signs of recurrence or disease in the follow-up period.
Discussion: The diagnostic gold standard of VL is direct visualization of the protozoans in specimens acquired from tissue biopsies or aspirations, as is the case with our patient. The first line treatment for VL is intravenous pentavalent antimonials, such as as meglumine antimoniate. However, due to the immunocompetent state of our patient and the asymptomatic presentation, the only treatment was therapeutic aspiration of the cyst.
Conclusion: Ultrasound guided aspiration of the cyst, with regular follow up with breast ultrasound, proved to be an effective method of managing visceral leishmaniasis in our patient.
Kumar A. Leishmania and leishmaniasis. 3rd Ed. New York: Springer-Verlag; 2013.
Pace D. Leishmaniasis. J Infect. 2014;69(Suppl1):S10-8.
Epub 2014 Sep 17
Kumar R, Kumari S, Prakash J, Kumar R. Atypical presentations of visceral leishmaniasis: A case series and review of literature. Trop J Med Res. 2015;18:109- 12.
Alimoglu E, Ceken K, Cassano E, Durum Y, Pestereli E. Breast involvement in visceral leishmaniasis. J Clin Ultrasound. 2009;37(9):531-3.
Gao Y, Saksena M, Brachtel E, Ter Meulenb D, Rafferty E. How to approach breast lesions in children and adolescents. Eur J Radiol. 2015;84(7):1350–1364.
Fernández-Roldán C, Fernández J, De Jesús S, Javier R, Martínez A, Tenorio C, et al. Leishmania antigens investigation in urine; clinical relevance in immuno-compromised patients; 2017.
[Cited 23 November 2019]
Stark C. Leishmaniasis treatment & management: Approach considerations, pharmacotherapy, management of cutaneous leishmaniasis; 2019.
[Cited 23 October 2019]
Frézard F, Demicheli C, Ribeiro RR. Pentavalent antimonials: New perspectives for old drugs. Molecules. 2009;14(7):2317-36.
Brandonisio O, Fumarola L, Spinelli R, Gradoni L. Unusual presentation of leishmaniasis as an adrenal cystic mass. Eur J Clin Microbiol Infect Dis. 2002;21(9): 682-3.
Epub 2002 Sep 7