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Atypical clinical presentation of visceral leishmaniasis in a patient with non‐Hodgkin lymphoma

Visceral leishmaniasis (VL) may have uncommon presentation in non-Hodgkin lymphomas (NHL) treated with drugs interfering with antibody production, like rituximab. A 60-year-old man with lymphoplasmacytic lymphoma, progressed because of anemia and splenomegaly, received bendamustine and rituximab, achieving complete remission. After 1 year, he presented general malaise, pancytopenia, and splenomegaly. Hypothesizing a relapse, bone marrow evaluation surprisingly demonstrated a leishmaniasis localization. Bone marrow cytology showed macrophages and extracellular space containing Leishmania amastigotes (Fig. 1A, magnification 40x). Each has a nucleus, some presented a kinetoplast (Fig. 1B, magnification 63x, indicated by arrow). Hematoxylin–eosin-stained bone marrow biopsy showed parasite aggregates within and outside the macrophages (Fig. 1C, magnification 40x); Giemsa staining allowed better morphological definition (Fig. 1D, magnification 40x). Successfully treated with amphotericin B, bone marrow re-evaluation showed no evidence of leishmania, the patient remained disease-free after 8 months. We considered this case of interest because of clinical atypical VL presentation and massive infiltration of bone marrow and spleen that could mimic NHL relapse.