Secondary myelofibrosis in visceral leishmaniasis - case report

A 39-year-old woman with a history of travel to the Montenegrin coast prese nted with a 9-month long history of fever and weakness, and on examination was found to be emaciated with hepatosplenomegaly and pancytopenia. Marrow aspiration showed poor cellularity with abundant Leishman Donovan (LD) bodi es in the macrophages. Bone marrow trephine biopsy revealed a marked myelof ibrosis (Manoharan classification: grade III) with osteosclerosis. The impr ession smears of a trephine biopsy stained with Guiemsa also showed LD bodi es. The patient did not exhibit evidence of any risk factors for visceral l eishmaniasis (VL). She was treated with meglumine antimoniate (Glucantime(( R))) without any adverse effect. The spleen returned to a normal volume aft er 4 months and bone marrow trephine biopsy performed 6 months after initia tion of the therapy had returned to normal. A diagnosis was difficult to es tablish as VL is rarely encountered in the continental parts of Yugoslavia, and with the presence of associated myelofibrosis it could easily have bee n mistaken for chronic idiopathic myelofibrosis. The association of myelofi brosis with visceral leishmaniasis has been reported in the literature only three times; we thus feel that documentation of this case is merited.