Endemic visceral leishmaniasis in a patient from lower Monferrato hills in provence of Alessandria, Italy

Visceral leishmaniasis is endemic in Italy as well as in the entire Mediterranean area and Campania is the italian region in which most cases occur. Dog leishmaniasis, common along the coast from Liguria to Southern Italy, is nowadays reported in areas as far inland as Monferrato hills, the outskirts of Turin and lake Garda southern shores. Mr. B.B. (male 67 years old) came almost by chance to the attention of our Medical department for acute fever and pancytopenia; further symptoms comprised subacute weight loss, splenic and limph node enlargment, an ulcerative lesion on the right arm. The patient appeared to be unavoidably destined to splenectomy until a Leishmania antibody test was requested to our laboratory. The assay was performed using an immunocromathographic method for specific IgM and by immunofluorescence to determine the total antibody titre towards Leishmania. Microscopic examination (Giemsa stain) and PCR were also performed to look for Leishmania infantum amastigotes in blood, bone marrow and skin. All tests, except microscopic examination, corroborated a Leishmania infection, and a dramatical clinical improvement was seen with Amphothericin B treatment. We conclude that an accurate anamnesis is mandatory if the Laboratory must be perform a rational diagnosis.