Fever of Unknown Origin: Don’t Forget Kala-Azar Even in Europe

  • Javier Moreno Díaz Internal Medicine Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
  • David De las Cuevas León Cardiology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
  • Ana Martinez González Rehabilitation Department, Hospital de Barbastro, Huesca, Spain
  • Rebeca Rubio Escuin Haematology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain


We present the case of a 70-year-old male patient with fever of unknown origin after a long period of convalescence from a previous admission to a chronic care hospital. During the admission, multiple combinations of antibiotic and antifungal treatments were prescribed, but with persistent fever and, eventually, neutropenia (200 lymphocytes, 0 neutrophils). Given the suspicion of infection at bone marrow level, a biopsy was performed as was serology of Leishmania, both diagnostic determinations.
Treatment with amphotericin B liposomal resulted in a good outcome.



  • Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, et al. Diagnosis and treatment of leishmaniasis: clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Am J Trop Med Hyg 2017;96:24–45.

  • Bogdan C, Rollinghoff M. The immune response to Leishmania: mechanisms of parasite control and evasion. Int J Parasitol 1998;28:121–34.

  • Bern C, Joshi AB, Jha SN, et al. Factors associated with visceral leishmaniasis in Nepal: bed-net use is strongly protective. Am J Trop Med Hyg 2000;63:184–8.

  • Sundar S, Rai M. Laboratory diagnosis of visceral leishmaniasis. 2002;9:951–8.

  • Antinori S, Calattini S, Longhi E, et al. Clinical use of polymerase chain reaction performed on peripheral blood and bone marrow samples for the diagnosis and monitoring of visceral leishmaniasis in HIV-infected and HIV-uninfected patients: a single-center, 8-year experience in Italy and review of the literature. Clin Infect Dis 2007;44:1602–10.
  • Published: 2017-12-06

    Issue: Vol 5 No 2 (view)

    Section: Articles

    How to cite:
    Moreno Díaz, J., De las Cuevas León, D., Martinez González, A., & Rubio Escuin, R. (2017). Fever of Unknown Origin: Don’t Forget Kala-Azar Even in Europe. European Journal of Case Reports in Internal Medicine, 5(2). https://doi.org/https://doi.org/10.12890/2017_000772

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