Visceral Leishmaniasis Complicated by Severe Anemia—Improvement Following Splenectomy

Abstract

Summary 1. Three patients with leishmaniasis previously reported have now been observed for 23 to 29 months following treatment and so can be presumed cured. 2. A fourth case of leishmaniasis has been discussed which was refractory to all usual dosages of neostibosan, stibanose, and diamidino stilbene. The anemia was so severe as to require the transfusion of 51 liters of whole blood during a period of 22 months. The leukopenia was severe and constant. The patient finally recovered following treatment by a combination of very massive dosage of diamidino stilbene and splenectomy. It seems reasonable to assume that the removal by splenectomy of a hitherto inaccessible focus of infection in the tremendously enlarged and infarcted spleen was instrumental in curing the patient. 3. The anemia and leukopenia disappeared following splenectomy. 4. This last fact leads the authors to postulate that the leukopenia in kala azar may be caused by the great proliferation of the reticulo-endothelial tissue in the spleen. 5. This report is not to be construed as suggesting the advisability of splenectomy in the usual case of visceral leishmaniasis.