Beyond Borders: A Rare Case of Visceral Leishmaniasis Presenting with Fulminant Hepatitis in a Non-Endemic Region

Hind Mohammed

Abstract

DOI 10.5281/zenodo.17181622

Introduction:Visceral leishmaniasis (VL), also known 
as kala-azar, is rare in Oman, a non-endemic country, 
making diagnosis challenging due to low clinical suspi- 
cion. 
Case Presentation: We describe a 25-year-old 
Ethiopian male who presented with a 4-day history 
of nausea, vomiting, epigastric pain, fever, and epis- 
taxis. Physical examination revealed jaundice and mas- 
sive hepatosplenomegaly (liver palpable 16 cm below 
the costal margin, spleen 18 cm). Initial laboratory 
tests showed elevated C-reactive protein, mild hepatic 
transaminase elevation, and pancytopenia. He was ini- 
tially treated for malaria without improvement. Twenty 
days later, persistent fever, fatigue, and recurrent epis- 
taxis prompted reevaluation. Bone marrow aspiration 
revealed Leishmania donovani amastigotes, and an 
rK39 rapid test was positive. Shortly after admission, 
the patient developed acute liver failure. Liver biopsy 
demonstrated acute hepatitis with confluent necrosis 
and numerous intracytoplasmic amastigotes; PCR con- 
firmed L. donovani. He was treated with liposomal 
amphotericin B (3 mg/kg daily for 5 days, with addi- 
tional doses on days 14 and 21). 
Outcome: The patient demonstrated gradual clinical 
and biochemical improvement and achieved complete 
recovery within one month. 
Conclusion: This rare case of VL with fulminant hep- 
atitis in a non-endemic setting highlights the impor- 
tance of considering VL in patients with relevant travel 
or migration history. Early diagnosis and timely therapy 
are essential for favorable outcomes and emphasize the 
need for heightened awareness and improved diagnostic 
access in both endemic and non-endemic regions