{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T18:45:18Z","timestamp":1775760318485,"version":"3.50.1"},"reference-count":37,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,5]]},"abstract":"<jats:p>In immunocompromised patients, visceral leishmaniasis (VL) can present with atypical clinical symptoms that include poor response to treatment. No optimal therapeutic regimen is available for such cases. In a splenectomized male patient, we observed a disseminated form of the disease in the liver, bone marrow, lymph nodes, and gastrointestinal tract. There was an apparent clinical improvement when he was initially treated with liposomal amphotericin B (L-AmB), but this was followed by a relapse involving severe clinical symptoms. He was finally treated successfully with a combination of L-AmB, meglumine antimoniate, and pentamidine isethionate. It is important to include asplenia as an immunosuppressive condition that induces exotic VL pathologies. In such cases, combination anti-<jats:italic>Leishmania<\/jats:italic> drug therapy should be considered.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0999","type":"journal-article","created":{"date-parts":[[2019,12,24]],"date-time":"2019-12-24T07:00:42Z","timestamp":1577170842000},"page":"268-273","source":"Crossref","is-referenced-by-count":7,"title":["Case Report: Combination Therapy with Liposomal Amphotericin B, N-Methyl Meglumine Antimoniate, and Pentamidine Isethionate for Disseminated Visceral Leishmaniasis in a Splenectomized Adult Patient"],"prefix":"10.4269","volume":"102","author":[{"given":"Hareton Teixeira","family":"Vechi","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Hospital Giselda Trigueiro, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Solange Vasconcelos de","family":"Sousa","sequence":"additional","affiliation":[{"name":"Hospital Giselda Trigueiro, Natal, Rio Grande do Norte, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirella Alves da","family":"Cunha","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital Giselda Trigueiro, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey Jon","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Instituto de Ci\u00eancias Biom\u00e9dicas, S\u00e3o Paulo University, S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kleber Giovanni","family":"Luz","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital Giselda Trigueiro, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Report of a Meeting of the WHO Expert Committee on Control of Leishmaniases","article-title":"Control of the Leishmaniases","author":"World Health Organization","year":"2010"},{"key":"b2","series-title":"PLoS One","first-page":"e35671","article-title":"Leishmaniasis worldwide and global estimates of its incidence","volume":"7","author":"Alvar","year":"2012"},{"key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e3136","article-title":"Visceral leishmaniasis and HIV coinfection in Latin America","volume":"8","author":"Lindoso","year":"2014"},{"key":"b4","series-title":"Int J Infect Dis","first-page":"e572","article-title":"Visceral leishmaniasis: host\u2013parasite interactions and clinical presentation in the immunocompetent and in the immunocompromised host","volume":"17","author":"Saporito","year":"2013"},{"key":"b5","series-title":"Clin Infect Dis","first-page":"e202","article-title":"Diagnosis and treatment of leishmaniasis: clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)","volume":"63","author":"Aronson","year":"2018"},{"key":"b6","series-title":"Leishmaniose Visceral: Recomenda\u00e7\u00f5es Cl\u00ednicas para Redu\u00e7\u00e3o da Letalidade","first-page":"17","author":"Minist\u00e9rio da Sa\u00fade do Brasil","year":"2011"},{"key":"b7","series-title":"Rev Chil Infectol","first-page":"216","article-title":"Leishmaniosis visceral en un paciente con infecci\u00f3n por VIH","volume":"30","author":"Olea","year":"2013"},{"key":"b8","series-title":"Cytojournal","first-page":"9","article-title":"Indian visceral leishmaniasis with extensive lymphadenopathy\u2013an unusual presentation: a case report with literature review","volume":"14","author":"Agarwal","year":"2017"},{"key":"b9","series-title":"Prog Pediatr Surg","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/978-3-642-70276-1_18","article-title":"Immunological consequences of splenectomy","volume":"18","author":"Eibl","year":"1985"},{"key":"b10","series-title":"Trop Geogr Med","first-page":"107","article-title":"Visceral leishmaniasis in Sudan. 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