{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T11:53:34Z","timestamp":1781697214111,"version":"3.54.5"},"reference-count":20,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,6,1]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>\n                    Visceral leishmaniasis (VL) is a systemic parasitic disease that predominantly involves the reticuloendothelial system, with pulmonary involvement being distinctly uncommon, particularly in individuals who are immunocompetent. We report a case of a middle-aged female who was immunocompetent presenting with acute hypoxaemic respiratory failure, characterised by progressive dyspnoea, bilateral lung consolidation and pleural effusion, initially mimicking severe pulmonary infection or haematological malignancy. The presence of pancytopenia, hypergammaglobulinaemia and massive hepatosplenomegaly raised suspicion of an underlying systemic disorder. Definitive diagnosis was established by demonstration of\n                    <jats:italic>Leishmania donovani<\/jats:italic>\n                    amastigotes in splenic aspirate, with further confirmation of direct pulmonary involvement through identification of intracellular amastigotes within alveolar macrophages on a transbronchial lung biopsy. The patient showed significant clinical and radiological improvement following treatment with liposomal amphotericin B and miltefosine. This case highlights that VL can rarely present with primary pulmonary manifestations even in immunocompetent hosts. It underscores the importance of considering VL in the differential diagnosis of unexplained pulmonary infiltrates with systemic features in endemic regions and demonstrates that histopathological confirmation from lung tissue can be crucial in establishing pulmonary involvement in atypical presentations.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2026-272797","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T11:15:21Z","timestamp":1781694921000},"page":"e272797","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary involvement in visceral leishmaniasis in the post-elimination era: a diagnostic masquerade"],"prefix":"10.1136","volume":"19","author":[{"given":"Deependra Kumar","family":"Rai","sequence":"first","affiliation":[{"name":"Pulmonary Medicine, All India Institute of Medical Sciences Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7872-8479","authenticated-orcid":false,"given":"Parul","family":"Sharma","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, All India Institute of Medical Sciences Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1643-9109","authenticated-orcid":false,"given":"Dhruv","family":"Talwar","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, All India Institute of Medical Sciences Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sreyashi","family":"Pal","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, All India Institute of Medical Sciences Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivam","family":"Sinha","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, All India Institute of Medical Sciences Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swati","family":"Swati","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, All India Institute of Medical Sciences Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niraj","family":"Singh","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, All India Institute of Medical Sciences Patna, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charul","family":"Dabral","sequence":"additional","affiliation":[{"name":"Pathology, Metro Hospital and Heart Institute Noida, Noida, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"2026061704151512000_19.6.e272797.1","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens12070969","article-title":"From Infection to Death: An Overview of the Pathogenesis of Visceral Leishmaniasis","volume":"12","author":"Costa","year":"2023","journal-title":"Pathogens"},{"key":"2026061704151512000_19.6.e272797.2","doi-asserted-by":"crossref","DOI":"10.7554\/eLife.02851","article-title":"Global distribution maps of the leishmaniases","volume":"3","author":"Pigott","year":"2014","journal-title":"Elife"},{"key":"2026061704151512000_19.6.e272797.3","unstructured":"National Vector Borne Disease Control Programme . Accelerated Plan for Kala-Azar Elimination 2017. New Delhi: Directorate of NVBDCP, 2017."},{"key":"2026061704151512000_19.6.e272797.4","first-page":"653","article-title":"Global leishmaniasis surveillance updates 2023: 3 years of the NTD road map","volume":"99","author":"Jain","year":"2024","journal-title":"Wkly Epidemiol Rec"},{"key":"2026061704151512000_19.6.e272797.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008319","article-title":"Prognostic factors for mortality among patients with visceral leishmaniasis in East Africa: Systematic review and meta-analysis","volume":"14","author":"Abongomera","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"2026061704151512000_19.6.e272797.6","doi-asserted-by":"publisher","DOI":"10.1007\/s00439-020-02130-w"},{"key":"2026061704151512000_19.6.e272797.7","unstructured":"Liapis K . Life cycle, epidemiology and clinical aspects of leishmaniasis. Georgios Gennimatas Hospital, 2019."},{"key":"2026061704151512000_19.6.e272797.8","doi-asserted-by":"crossref","first-page":"785","DOI":"10.18535\/jmscr\/v8i1.125","article-title":"Visceral leishmaniasis: a rare cause of fever of unknown origin in this part of the country","volume":"8","author":"Tankala","year":"2020","journal-title":"J Med Sci Clin Res"},{"key":"2026061704151512000_19.6.e272797.9","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.7326\/0003-4819-114-12-1064_2","article-title":"Leishmania in bronchoalveolar lavage","volume":"114","author":"Rosenthal","year":"1991","journal-title":"Ann Intern Med"},{"key":"2026061704151512000_19.6.e272797.10","doi-asserted-by":"crossref","DOI":"10.1155\/2011\/561985","article-title":"Visceral leishmaniasis with endobronchial involvement in an immunocompetent adult","volume":"2011","author":"Kotsifas","year":"2011","journal-title":"Case Rep Med"},{"key":"2026061704151512000_19.6.e272797.11","first-page":"541","article-title":"Pulmonary involvement in human visceral leishmaniasis: clinical and tomographic evaluation","volume":"43","author":"Bispo","year":"2010","journal-title":"Rev Soc Bras Med Trop"},{"key":"2026061704151512000_19.6.e272797.12","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1111\/tmi.12877","article-title":"Causes and consequences of higher Leishmania infantum burden in patients with kala-azar: a study of 625 patients","volume":"22","author":"Zacarias","year":"2017","journal-title":"Trop Med Int Health"},{"key":"2026061704151512000_19.6.e272797.13","doi-asserted-by":"publisher","DOI":"10.1590\/S0037-86822010000400010"},{"key":"2026061704151512000_19.6.e272797.14","doi-asserted-by":"publisher","DOI":"10.1080\/00365540410020550"},{"key":"2026061704151512000_19.6.e272797.15","doi-asserted-by":"crossref","DOI":"10.3390\/reports9010029","article-title":"Case Reports of Visceral Leishmaniasis-Associated Hemophagocytic Lymphohistiocytosis in Adults: A Complex Immune Phenomenon","volume":"9","author":"Bougiouklou","year":"2026","journal-title":"Reports (MDPI)"},{"key":"2026061704151512000_19.6.e272797.16","doi-asserted-by":"crossref","first-page":"450","DOI":"10.4103\/ijd.IJD_439_20","article-title":"Post Kala-azar Dermal Leishmaniasis","volume":"65","author":"Das","year":"2020","journal-title":"Indian J Dermatol"},{"key":"2026061704151512000_19.6.e272797.17","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0377-1237(17)30800-6","article-title":"MANAGEMENT OF KALA AZAR - AN UPDATE","volume":"52","author":"Kalra","year":"1996","journal-title":"Med J Armed Forces India"},{"key":"2026061704151512000_19.6.e272797.18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0903627"},{"key":"2026061704151512000_19.6.e272797.19","doi-asserted-by":"crossref","first-page":"308","DOI":"10.4269\/ajtmh.19-0931","article-title":"Combination Therapy Against Indian Visceral Leishmaniasis with Liposomal Amphotericin B (FungisomeTM) and Short-Course Miltefosine in Comparison to Miltefosine Monotherapy","volume":"103","author":"Goswami","year":"2020","journal-title":"Am J Trop Med Hyg"},{"key":"2026061704151512000_19.6.e272797.20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008429","article-title":"Long-term incidence of relapse and post-kala-azar dermal leishmaniasis after three different visceral leishmaniasis treatment regimens in Bihar, India","volume":"14","author":"Goyal","year":"2020","journal-title":"PLoS Negl Trop Dis"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272797","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T11:15:29Z","timestamp":1781694929000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272797"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":20,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,17]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bcr-2026-272797"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272797","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}