Case Report Visceral Leishmaniasis: A Differential Diagnosis to Remember after Bone Marrow Transplantation Margarida Dantas Brito, 1 Fernando Campilho, 1 Rosa Branca, 1 Carlos Pinho Vaz, 1 Cristina Silva, 2 Teresa Sousa, 2 Carlos Mendes, 2 and António Campos 1 1 Bone Marrow Transplantation Service, Instituto Portuguˆ es de Oncologia Francisco Gentil, Rua Dr. Ant´ onio Bernardino de Almeida, 4200-072 Porto, Portugal 2 Laboratory of Hematology, Instituto Portuguˆ es de Oncologia Francisco Gentil, Rua Dr. Ant´ onio Bernardino de Almeida, 4200-072 Porto, Portugal Correspondence should be addressed to Margarida Dantas Brito; ana.margarida.dantas@gmail.com Received 18 September 2014; Accepted 23 November 2014; Published 11 December 2014 Academic Editor: Massimo Gentile Copyright © 2014 Margarida Dantas Brito et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Leishmania infection in immunocompromised hosts is reported in the literature, mostly concerning human immunodefciency virus infected patients. It is not well characterized in the context of stem cell transplantation. We report a rare case clinical case of visceral leishmaniasis afer allogeneic bone marrow transplantation. A 50-year-old Caucasian male was referred to allogeneic bone marrow transplantation with a high-risk acute lymphoblastic B leukemia in frst complete remission. Allogeneic SCT was performed with peripheral blood stem cells from an unrelated Portuguese matched donor. In the following months, patient developed mild fuctuating cytopenias, mostly thrombocytopenia (between 60 and 80*10 9 /L). Te only signifcant complaint was intermittent tiredness. Te common causes for thrombocytopenia in this setting were excluded—no evidence of graf versus host disease, no signs of viral or bacterial infection, and no signs of relapsed disease/dysplastic changes. Te bone marrow smear performed 12 months afer transplantation revealed an unsuspected diagnosis: a massive bone marrow infltration with amastigotes. 1. Introduction Leishmaniasis is an emerging infectious disease, with increas- ing reports in endemic and nonendemic countries [1]. Addi- tionally, in the past years, some case reports of leishmania infection in immunocompromised hosts appeared in the lit- erature. Most reports refer to HIV infected patients or clinical cases in the setting of solid organ transplantation. Tere are scarse reports in the context of stem cell transplantation (SCT) [2–4]. Te aim of this case report is to present a case of visceral leishmaniasis afer allogeneic SCT. 2. Case Presentation A 50-year-old Caucasian male, with no relevant past med- ical records, was referred to SCT with a high-risk acute lymphoblastic B leukemia in frst complete remission (CR). Allogeneic SCT was performed with peripheral blood stem cells from an unrelated Portuguese matched 9/10 donor (disparity in locus HLA-A), afer myeloablative conditioning regimen (with busulfan, cyclophosphamide, and antilym- phocytic serum). Graf versus host disease prophylaxis was performed with tacrolimus and methotrexate. Tere were no major complications during neutropenic period. Corti- cotherapy was prescribed for upper digestive graf versus host disease diagnosed 2 months afer SCT. In the follow- ing months, patient developed mild fuctuating cytopenias, mostly thrombocytopenia (between 60 and 80*10 9 /L). Te only signifcant complaint was intermittent tiredness. Bone marrow evaluation had no signs of relapse disease and patient had complete chimerism. Te common causes for thrombo- cytopenia were excluded—no evidence of graf versus host disease; no signs of viral or bacterial infection; and no signs of relapsed disease/dysplastic changes. Te bone marrow smear performed 12 months afer transplant revealed an unsus- pected diagnosis: a massive bone marrow infltration with Hindawi Publishing Corporation Case Reports in Hematology Volume 2014, Article ID 587912, 2 pages http://dx.doi.org/10.1155/2014/587912