We present the case of a forty-year-old man, living in an endemic area of ​​leishmania, with constitutional symptoms, visual loss, epigastralgia, fever and pancytopenia, with five months evolution. The serology of leishmania IgG and IgM were positive and the myelogram showed a normocellular bone marrow with amastigotes of leishmania in the smear. To evaluate ocular involvement, we performed a retinography (Fig.1), which showed retinal haemorrhages, multiple, bioculares, superficial and deep, with areas of retinal ischemia. The patient was treated with miltefosine, after a anaphylactic reaction to liposomal Amphotericin B, with clinical improvement. Reassessed in a consultation five months after the treatment with complete resolution of the previous ophthalmic changes (Fig.2).

The suspicion of leishmania infection should be particularly high in endemic countries such as France, Italy, Spain and Portugal. Specifically in Portugal, the Alto Douro Region and the Metropolitan Region of Lisbon are areas of high incidence of Kalasar. ¹

The retinal attainment has previously been noted in visceral leishmaniasis, but its clinical and pathological significance are unknown.² These changes appear to result from the loss of local microvascular autoregulation, which suggests an underlying preexisting inflammatory etiology, such as that present in retinal vasculopathy.³

Figura I

Initial retinography

Figura II

Post-treatment retinography

  BIBLIOGRAFIA  

1. Campino L, Maia C. Epidemiologia das leishmanioses em Portugal. Acta Med Port. 2010; 23(5):859-864.

2. Maude RJ, Ahmed BW, Rahman AHMW, et al. Retinal changes in visceral leishmaniasis by retinal photography. BMC Infect Dis 2014; 14: 527. DOI:10.1186/1471-2334-14-527

3. Petersen C.A., Greenlee M.H. Neurologic Manifestations of Leishmania spp Infection. J Neuroparasitol. 2011; 2: N110401. [Accessed February 2, 2021] Available in: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110707