TRANSFUSION COMPLICATIONS Transfusion-transmitted visceral leishmaniasis caused by Leishmania (Leishmania) mexicana in an immunocompromised patient: a case report Laureano Mestra, Liliana Lopez, Sara M. Robledo, Carlos E. Muskus, Rubén S. Nicholls, and Iván Darío Vélez BACKGROUND: Transfusion-transmitted leishmaniasis is an increasing problem in areas where visceral and cutaneous leishmaniases are endemic. CASE REPORT: This article reports a case of transfusion-transmitted fatal visceral leishmaniasis (VL) caused by Leishmania (Leishmania) mexicana in a 42-year-old male resident of northwestern Colombia who after developing a terminal renal failure due to lupus nephritis received a renal transplant and multiple transfusions. RESULTS: Multiple intracellular Leishmania amastig- otes were demonstrated in both renal biopsy and marrow aspirates. Cultures of the parasite were obtained in NNN medium and the identification of the species was done both by direct immunofluorescence and polymerase chain reaction–restriction fragment length polymorphism. CONCLUSIONS: This is the first report of a VL case produced by L. (L.) mexicana in Colombia, which usually is a dermotropic species. Our report suggests that although leishmaniasis is transmitted by the bite of phlebotomine sand flies, Leishmania parasite may be transmitted by blood transfusion, complicating the clini- cal course of organ transplant and being fatal. V isceral leishmaniasis (VL) is basically a disease of children and adults. However, cell-mediated immune deficiency increases the susceptibility to this infection. VL affects immunosuppressed individuals, especially human immunodeficiency virus (HIV) patients and less frequently organ transplant recipi- ents and atypical manifestations of the disease may also occur. 1 VL is usually caused by the Leishmania donovani complex species: L. (L.) donovani (in Asia and Africa) and L. (L.) infantum (in the Mediterranean basin, West Africa, and South America, including Colombia). Other Leish- mania species such as L. (L.) tropica (in the Middle East) or L. (L.) amazonensis (in South America) are occasion- ally viscerotropic. 2,3 Here we report a case of fatal VL caused by L. (L.) mexicana,a Leishmania species that typically produces cutaneous ulcers, mainly on the face and ears, but has also been involved in Leishmania HIV co-infection cases. 3 In Colombia L. (L.) mexicana has a limited distribution with small foci in the departments of Caldas, Putumayo, Nariño, Santander, and Antioquia. 4-8 This is the first report in Colombia of a VL case caused by L. (L.) mexicana in an immunocompromised patient after receiving multiple blood transfusions and a renal transplant. CASE REPORT A 42-year-old male native from Medellin (Colombia), after developing a terminal renal failure due to lupus nephritis diagnosed in 2001, received a renal transplant in April 2004. After the transplant, the patient showed anemia, mycophenolate mofetil–associated thrombocytopenia, and leukopenia, for which he received multiple blood and platelet transfusions. Subsequently, the patient experi- enced a Grade 1 acute graft rejection accompanied by hepatosplenomegaly. On Day 32 posttransplant, the patient presented fever and the screening for antibodies against Trypanosoma cruzi by enzyme-linked immun- osorbent assay (ELISA) was positive. Treatment with ben- znidazole was started but suspended 8 days later because From the Programa de Estudio y Control de Enfermedades Tropicales-PECET, Facultad de Medicina, Universidad de Antio- quia, Medellín; and Grupo de Parasitología, Instituto Nacional de Salud, Bogotá, Colombia. Address reprint requests to: Iván Darío Vélez, MD, PhD, Pro- grama de Estudio y Control de Enfermedades Tropicales-PECET, Facultad de Medicina, Universidad de Antioquia, Carrera 53 No. 61-30. Medellin, Colombia; e-mail: idvelez@pecet-colombia.org. Received for publication July 26, 2010; revision received November 22, 2010, and accepted December 22, 2010. doi: 10.1111/j.1537-2995.2011.03092.x TRANSFUSION 2011;51:1919-1923. ABBREVIATION: VL = visceral leishmaniasis. Volume 51, September 2011 TRANSFUSION 1919