Contrasting outcomes of visceral leishmaniasis in two patients with membranous nephropathy receiving immunosuppressive therapy: a case report.

BACKGROUND

Visceral leishmaniasis (VL) often presents with an atypical and fulminant course in immunocompromised hosts, and treatment faces multiple challenges including drug toxicity, immunosuppressive status, and complications.

CASE PRESENTATION: Here we report two cases of VL in patients with membranous nephropathy(MN) who developed the infection after long-term immunosuppressive therapy. Both patients presented with fever, pancytopenia, and markedly elevated inflammatory markers. Case 1 had relapsed VL complicated by pre-existing renal insufficiency, experienced disease relapse after anti-parasitic treatment, and ultimately died of multi-organ failure. Case 2 developed hemophagocytic lymphohistiocytosis (HLH) but achieved clinical reversal after the addition of glucocorticoids to anti-parasitic therapy. Both patients received standard treatment with amphotericin B cholesteryl sulfate complex (ABCD). However, Case 1 with pre-existing renal insufficiency eventually died, whereas Case 2 with a milder degree of immunosuppression was successfully cured.

CONCLUSION

These cases suggest that when patients with MN develop VL after long-term immunosuppressive therapy, treatment faces multiple challenges including renal insufficiency, depth of immunosuppression, and secondary HLH, necessitating individualized and comprehensive management.