[Myelitis Associated with Visceral Leishmaniasis Due to Leishmania infantum in Burkina Faso: A Case Report].

Abstract

Introduction: Visceral leishmaniasis with Leishmania infantum (VL/LI) remains unreported in West Africa. We describe here an unprecedented autochthonous case of VL/LI in Burkina Faso, associated with myelitis.

Case report: A teenage girl was hospitalized for prolonged fever, flaccid paraplegia, severe pancytopenia, hepatosplenomegaly, and immobilization-related pulmonary embolism with pleural effusion. Immunological, hematological, and microbiological investigations, including tuberculosis, particularly on pleural, bone marrow fluids, and salivary gland biopsy were non-diagnostic. Spinal MRI revealed thoracic myelitis. Empirical anti-tuberculous and immunosuppressive drugs for sarcoidosis (methylprednisolone/adalimumab) were ineffective and favoured ulcero-necrotic cutaneous nodules emergence, prompting VL diagnostic, confirmed by LI PCR positivity on cutaneous and blood samples.

Conclusion: Although VL/LI is reported in local domestic dogs, this case provides the first documentation of human VL/LI in West Africa, endemic region for L. major, associated with a probable specific myelitis. This case is reminiscent of the exceptional involvements of central nervous system in the clinical spectrum of VL.