{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T06:26:35Z","timestamp":1765261595065,"version":"3.46.0"},"reference-count":33,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T00:00:00Z","timestamp":1762646400000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    We report a diagnostically complex case of visceral leishmaniasis (Kala\u2010azar) in a 73\u2010year\u2010old male from a country where the disease was eliminated in 2023. The patient presented with a 2\u2010month history of low\u2010grade fever, fatigue, progressive skin hyperpigmentation over 2\u2009years, and hepatosplenomegaly. Initial investigations revealed pancytopenia (hemoglobin 10.4\u2009g\/dL, white blood cells 3500\/mm\n                    <jats:sup>3<\/jats:sup>\n                    , platelets 60,000\/mm\n                    <jats:sup>3<\/jats:sup>\n                    ), prompting a differential diagnosis of Kala\u2010azar versus myelodysplastic syndrome (MDS). The rapid diagnostic test (rK39) for Kala\u2010azar was positive, but bone marrow examination showed dysplastic changes, hypercellularity, decreased myeloid\u2010erythroid ratio, binucleate erythrocytes, and maturation arrest at the myelocyte stage without Leishmania donovani (LD) bodies, complicating the diagnosis. Financial constraints precluded fluorescence in\u00a0situ hybridization (FISH) testing for MDS confirmation. Repeated peripheral blood film (PBF) and rK39 testing (qDetect Kala\u2010azar) on February 6, 2025, confirmed Kala\u2010azar, ruling out MDS as the primary pathology. The patient responded well to liposomal amphotericin B treatment (3\u2009mg\/kg\/day according to WHO regimen). This case underscores the challenge of diagnosing Kala\u2010azar in post\u2010elimination settings, particularly when clinical and laboratory features overlap with hematological disorders like MDS. It highlights the critical need for persistent diagnostic evaluation, including repeated serological and hematological testing, to differentiate infectious causes from malignancies in patients with unexplained pancytopenia. Clinicians must remain vigilant for re\u2010emerging infectious diseases, even in regions where they are deemed eliminated, to ensure accurate diagnosis and prompt treatment, ultimately improving patient outcomes in resource\u2010limited settings.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.71402","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T03:39:41Z","timestamp":1762745981000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Forgotten Foe Returns: The Diagnostic Odyssey of Kala\u2010Azar Masquerading as Myelodysplastic Syndrome in a Post\u2010Elimination Era"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5585-9787","authenticated-orcid":false,"given":"Sumaya Khan","family":"Mifty","sequence":"first","affiliation":[{"name":"Dhaka Medical College and Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4246-7502","authenticated-orcid":false,"given":"Saiful Islam","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Dhaka Medical College and Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tahmidur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Dhaka Medical College and Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanveer Al Razi","family":"Khan","sequence":"additional","affiliation":[{"name":"Dhaka Medical College and Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swagota","family":"Roy","sequence":"additional","affiliation":[{"name":"Dhaka Medical College and Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faiza","family":"Ahmmed","sequence":"additional","affiliation":[{"name":"Dhaka Medical College and Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Md. Sabbir","family":"Hossain","sequence":"additional","affiliation":[{"name":"Dhaka Medical College and Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8995-1058","authenticated-orcid":false,"given":"Ibrahim","family":"Khalil","sequence":"additional","affiliation":[{"name":"Dhaka Medical College and Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,9]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"World Health Organization Leishmaniasis https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/leishmaniasis."},{"volume-title":"Yellow Book 2025","year":"2025","author":"Centers for Disease Control and Prevention","key":"e_1_2_11_3_1"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.02851"},{"issue":"35","key":"e_1_2_11_5_1","first-page":"401","article-title":"Global Leishmaniasis Surveillance: 2019\u20102020, a Baseline for the 2030 Roadmap","volume":"96","author":"Ruiz\u2010Postigo J. 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