{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:28:39Z","timestamp":1786512519527,"version":"build-2736575974"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Visceral leishmaniasis (VL) often presents with an atypical and fulminant course in immunocompromised hosts, and treatment faces multiple challenges including drug toxicity, immunosuppressive status, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>Here we report two cases of VL in patients with membranous nephropathy(MN) who developed the infection after long-term immunosuppressive therapy. Both patients presented with fever, pancytopenia, and markedly elevated inflammatory markers. Case 1 had relapsed VL complicated by pre-existing renal insufficiency, experienced disease relapse after anti-parasitic treatment, and ultimately died of multi-organ failure. Case 2 developed hemophagocytic lymphohistiocytosis (HLH) but achieved clinical reversal after the addition of glucocorticoids to anti-parasitic therapy. Both patients received standard treatment with amphotericin B cholesteryl sulfate complex (ABCD). However, Case 1 with pre-existing renal insufficiency eventually died, whereas Case 2 with a milder degree of immunosuppression was successfully cured.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These cases suggest that when patients with MN develop VL after long-term immunosuppressive therapy, treatment faces multiple challenges including renal insufficiency, depth of immunosuppression, and secondary HLH, necessitating individualized and comprehensive management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1889409","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:47:55Z","timestamp":1786510075000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Contrasting outcomes of visceral leishmaniasis in two patients with membranous nephropathy receiving immunosuppressive therapy: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiu","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Infection, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Infection, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruixian","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Infection, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"E16","DOI":"10.12788\/cutis.0876","article-title":"What's eating you? 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