Fareena Bilwani, Mohammad Aslam, Salman N Adil, Ghulam Nabi Kakepoto, Mohammad Khurshid.
Usefulness of Bone Marrow Examination in the diagnosis of a patient with Visceral Leishmaniasis and HIV.
Infect Dis J Jan ;13(1):22-3.

A 55 year old male, presented with complains of dry cough along with fever since 9 months. His fever was low grade with an evening rise associated with night sweats. He also complained of 5 episodes of loose watery diarrhea per day 5 days prior to admission. His past medical history revealed that 2 months prior to admission his chest x-ray was done on outpatient which showed bilateral basal atelectasis. Later on his CT scan chest was done which showed mediastinal lymphadenopathy. His lung biopsy was subsequently performed which showed chronic granulomatous inflammation. Subsequently, he was started on anti-tuberculous therapy. He showed no response to ATT. After a month of treatment he developed rashes all over his body and suspecting a drug reaction, his medication stopped. His personal and family history was unremarkable. At the time of presentation on general examination, his was pale with macular rashes all over his body. There was also decreased air entry on left base of lung. There was hepatosplenomegaly. Rest of examination was normal. His complete blood counts showed Hb: 9gm, WBC 1,000/cmm, platelets: 30,000/cmm. His bone marrow aspirate, biopsy and cultures were done for workup. Bone marrow aspirate and trephine revealed presence of Leishmania donovoni. He was also found positive for HIV1 and 2 antibodies which were later confirmed by Western Blot. He was promptly started on sodium stibogluconate. Later on he developed bronchopneumonia and died of septic shock.

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