Clinical and Laboratory Predictors for Differentiating Visceral Leishmaniasis from Hematological Malignancies in Adults with Pancytopenia.

Visceral leishmaniasis (VL) is a systemic, life-threatening zoonotic disease. VL and hematological malignancies (HMs) may present with overlapping clinical and laboratory features. The primary endpoint of our study was to identify the clinical and laboratory parameters for differentiating VL from HMs in adult patients with pancytopenia. The secondary endpoint was to evaluate the clinical and laboratory findings in patients with VL. In this 15.5-year retrospective case-control study, adult patients with pancytopenia who were diagnosed with VL or HMs at a tertiary referral hospital in Antalya were included. A total of 53 patients were included (VL, n = 24; HMs, n = 29). The VL group was younger and presented with a significantly longer duration from symptom onset to hospital admission compared to the HMs group (each, p < 0.001). Fever, anorexia, left upper quadrant pain, and hepatosplenomegaly were more frequent in the VL group (each, p < 0.001). The VL group exhibited significantly elevated C-reactive protein (CRP), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT) and total protein levels, and lower albumin levels. A reversed albumin-globulin ratio was present in 79% of patients with VL. The splenic long axis was independently associated with VL diagnosis (OR: 2.45, 95% CI: 1.31-4.59, p = 0.005). The highest discriminatory performance was achieved with a splenic long axis cut-off of >13.75 cm (AUC: 0.945, sensitivity: 92%, specificity: 93%), followed by CRP >33.5 mg/L (AUC: 0.817, sensitivity: 83%, specificity: 83%) and symptom duration >52.5 days (AUC: 0.799, sensitivity: 67%, specificity: 86%). VL should be considered in the differential diagnosis of adults with pancytopenia, particularly in endemic regions. We believe that our findings may contribute to earlier and more accurate diagnosis of VL. Prolonged symptom duration, hepatosplenomegaly, elevated AST, elevated CRP, hyperproteinemia, hypoalbuminemia, and reversed albumin-globulin ratio necessitate a high index of clinical suspicion for VL compared to HMs.