Therapy of visceral leishmaniasis in renal transplant recipients intolerant to pentavalent antimonials

Visceral leishmaniasis should be suspected in renal transplant recipients i n whom a fever develops of unknown origin. A 53-year-old renal transplant r ecipient developed pyrexia, hepatosplenomegaly, and pancytopenia 4 years af ter transplantation. Antileishmaniasis serology was negative, and the diagn osis was confirmed through bone marrow examination. Treatment with glucanti ne (N-methylglucamine antimoniate) led to acute pancreatitis, and treatment with ketoconazole plus allopurinol for 21 days was effective to eradicate Leishmania donovani.