{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T09:57:53Z","timestamp":1790675873543,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Visceral leishmaniasis (VL)\u2013associated hemophagocytic lymphohistiocytosis (HLH) is a rare but life\u2010threatening hyperinflammatory syndrome. Diagnosis is often challenging due to overlapping clinical features, especially in low\u2010endemic regions, where VL is not initially suspected. Severe hepatic dysfunction can further obscure the diagnosis and complicate treatment. We report a 14\u2010year\u2010old male from West Gojjam, Ethiopia, presenting initially with jaundice and clinical features of acute hepatitis. Over 3\u2009months, he developed progressive abdominal distension, fever, pancytopenia, and coagulopathy. Imaging showed hepatosplenomegaly and ascites; viral and autoimmune hepatitis were excluded. Bone marrow examination revealed\n                    <jats:italic>Leishmania donovani<\/jats:italic>\n                    amastigotes and hemophagocytosis, confirming VL\u2010triggered secondary HLH. Due to severe hepatic impairment, etoposide was withheld. The patient was treated with intravenous dexamethasone and a six\u2010day course of liposomal amphotericin B, along with supportive care. Clinical and laboratory parameters improved steadily, with full recovery by 4\u2009weeks. VL\u2010HLH should be considered in patients with hepatitis\u2010like presentations, even in low\u2010endemic areas. Early recognition and treatment targeting the underlying infection with amphotericin B plus corticosteroids can achieve favorable outcomes, even when etoposide is contraindicated.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.71351","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T11:33:21Z","timestamp":1761219201000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["When Hepatitis Masks Visceral Leishmaniasis: A Case of Secondary\n                    <scp>HLH<\/scp>\n                    in a Low\u2010Endemic Region"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0061-6458","authenticated-orcid":false,"given":"Chernet T.","family":"Mengistie","sequence":"first","affiliation":[{"name":"School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4647-111X","authenticated-orcid":false,"given":"Biruk T.","family":"Mengistie","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4127-4846","authenticated-orcid":false,"given":"Temesgen H.","family":"Gebremeskel","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Muluneh","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rediet G.","family":"Kebede","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13045-024-01621-x"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1369687"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2020.101515"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-06-356261"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms10101887"},{"issue":"35","key":"e_1_2_14_7_1","first-page":"401","article-title":"Global Leishmaniasis Surveillance: 2019\u20132020, a Baseline for the 2030 Roadmap\/Surveillance Mondiale de la Leishmaniose: 2019\u20132020, Une Periode de Reference Pour la Feuille de Route a L'horizon 2030","volume":"96","author":"Ruiz\u2010Postigo J. A.","year":"2021","journal-title":"Weekly Epidemiological Record"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw742"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpr3.12059"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idcr.2024.e02059"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2020.05.056"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2025.1561600"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-021-06408-w"},{"key":"e_1_2_14_14_1","unstructured":"World Health Organization \u201cStatus of Endemicity of Visceral Leishmaniasis. World Health Organization \u201d(2025) https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator\u2010details\/GHO\/status\u2010of\u2010endemicity\u2010of\u2010visceral\u2010leishmaniasis."},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13071-015-0883-5"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1407.071589"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000003086"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12288-015-0541-2"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1590\/1984-0462\/2022\/40\/2020269"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21039"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2018.05.031"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71351","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.71351","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71351","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T08:54:47Z","timestamp":1790240087000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.71351"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":20,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1002\/ccr3.71351"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.71351","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2025-08-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71351"}}