Presentation of case: A 20 year old men from Simanjiro district in northern Tanzania presented witha 3 year history of splenomegaly, fatigue, cachexia, skin maculae and recent onset of watery diarrheaat Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. Due to laboratory findings of pancytopenia, diagnostic workup included bone marrow aspiration cytology and biopsy. Although the rapid test (IT LEISH, rK39 RDT) was negative, blood smear showed amastigote forms of Leishmaniasisin macrophages. Repeat bone marrow aspiration and PCR eventually confirmed VL. The patient denied travel to known endemic areas of visceral leishmaniasis (VL).Treatment was initiated with Amphotericin B, but the patient died on the fourth day of treatment from respiratory insufficiency. An autopsy revealed massive organ manifestations of VL.

Case discussion:

This is the first reported autochthonous case of VL in Tanzania. Clark et al. detected the vectorPhlebotomous martini in Northern Tanzania in 2013, in a region boardering the district of our patient.The negative rapid test draws attention to the fact that sensitivity and specificity was found to be lowin East African VL patients as displayed earlier by a Kenyan study. Therefore, tissue samples (spleenor bone marrow) remain necessary for diagnosis. The variety of symptoms in this presented casewas remarkable, including the occurrence of Post Kala Azar Dermal Leishmaniasis (PKDL) and VLat the same time. This has been described in East African VL cases before as well as the occurrenceof chronic diarrhea. An elongated undiagnosed period likely led to a mixed clinical picture that included: hepato-splenomegaly, PKDL, cachexia, and diarrhea.