Glomerulonephritis Following Visceral Leishmaniasis; A Case Report

Abstract

Visceral leishmaniosis (VL) is an endemic systemic infection in various parts of Iran. Renal failure is often seen in VL which is usually mild and related to interstitial nephritis, as glomerular involvement is rarely found. This study reports a case of a 20-year-old Iranian male who presented with myalgia, arthralgia, chills, cough, and a significant weight loss of 20 kg over the past two months. In addition, the patient reported a past history of ITP from two months ago which was treated with prednisolone 35 mg daily & a history of animal contact (cat). On physical examination, he had petechiae, purpura over the limbs and trunk, and a significantly enlarged palpable spleen. On laboratory evaluations, we found a platelet count of 6000/μL, impaired liver function tests, serum creatinine level of 1.5 mg/dL, blood urea nitrogen level of 21 mg/dL, proteinuria on 24-hour urine collection analysis, positive results for antinuclear antibodies, and a low level of C3 complement. Microscopic examination of PBS demonstrated thrombocytopenia, no schistocyte and the identification of Leishman bodies was positive. Bone marrow biopsy showed intracellular Leishman parasites. After correction of thrombocytopenia, a kidney biopsy was performed that revealed mesangial proliferative glomerulonephritis. Accordingly, the patient was treated with liposomal amphotericin B for 21 days, following which his condition improved significantly. This case report discusses the association between glomerulonephritis and VL and focuses on endemic infections as a potential underlying cause of manifested renal disease.

Keywords: Glomerulonephritis, Kala-azar, Mesangial proliferative glomerulonephritis, Visceral leishmaniosis