Diagnosis of Leishmania donovani infection via bronchoalveolar lavage fluid next-generation sequencing:A case report

Visceral leishmaniasis usually presents with fever, weight loss, enlargement of the spleen and liver, and anemia. Its diagnosis relies on etiological examination, typically by detecting Leishmania parasites in smears of bone marrow, splenic, or lymph node aspirates. We report a case of Leishmania infection presenting predominantly as interstitial pneumonia. The patient showed no significant improvement in pulmonary lesions after empirical antibiotic therapy. Targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid (BALF) detected Leishmania donovani species complex. The pulmonary lesions gradually resolved following standard treatment with amphotericin B colloidal dispersion. Through a comprehensive review of previous studies, we examined the pulmonary manifestations of visceral leishmaniasis, encompassing both interstitial pneumonia and secondary parasitic lung infections. Based on our findings, we emphasize the need for enhanced clinical recognition of visceral leishmaniasis-related pulmonary complications among healthcare professionals. Furthermore, we addressed the limitations of this case report.