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Table 1 Epidemiological characteristics of seven immunosuppressed patients with visceral leishmaniasis, 2009–2018, Norway

From: Imported visceral leishmaniasis and immunosuppression in seven Norwegian patients

Case no Sex Age Chronic underlying disease Immunosuppressive treatment Fever, splenomegaly, weight loss Other clinical features and duration of symptoms at diagnosis Travel history Likely place of transmission
Patient 1 M 66 Rheumatoid arthritis, MTX 17.5 mg/week for 7 years and adalimumab Yes 6 months of constitutional symptoms and oesophageal candidiasis. A chronic skin ulcer acquired in Spain one year ago was diagnosed as CL. Then, a prednisolone course due to worsening of RA was followed by the clinical picture of VL Recreational travel to Spain > one year ago Spain
Patient 2 M 78 Psoriasis arthritis MTX 20 mg/week for > 5 years and prednisolone Yes Weight loss over a year. While in Thailand, fever and asthenia developed hospitalization. Splenectomy was performed after 10 days in hospital due to intractable pancytopenia Several recreational travels to Thailand the last year; the last five years to Spain. Professional travels to Pakistan, East Africa and India the last 20 years Unknown
Patient 3 M 79 Rheumatoid arthritis MTX12.5 mg/week for several years and prednisolone Yes 6 weeks of constitutional symptoms, prior to VL diagnosis. 16 months after treatment, he fell sick from a testis B-cell lymphoma. He then had a relapse of VL, prior to cytostatic treatment Recreational travels to Spain one year, to Turkey 8 years and to Italy, Spain, Portugal some 20 years ago, respectively Unknown
Patient 4 M 57 Myelofibrosis No Yes Salmonella gastroenteritis while in Tanzania. Admitted 2 months later with constitutional symptoms and increasing weight loss 5–15 kg. Holiday house in Spain. Recreational travel to Tanzania 2 months ago Spain
Patient 5 M 41 HIV No Yes Constitutional symptoms and 15 kg weight loss the last two months. On admission he had oesophageal candidiasis; HIV and VL were diagnosed respectively. Relapse of VL after 3 months, CD4, 119/ml Prior to 2010 he lived in Portugal. He then lived in South Africa 2010–12, in Cape Verde 2012–14; thereafter in Norway. Many recreational and profession travels in Spain. Spain, Portugal
Patient 6 M 83 Rheumatoid arthritis MTX 20 mg/week for 10 months, initially together with prednisolone, but last 6 months MTX alone Yes Admitted with constitutional symptoms, two weeks after returning from Spain. Extensive diagnostic work-up and progressive weight loss 4-13 kg until diagnosed VL Recreational travel to Spain Spain
Patient 7 F 46 Ulcerative colitis Azathioprine and infliximab for 1.5 years – discontinued 6 and 8 months after symptoms respectively Yes Splenectomy on the suspicion of lymphoma Recreational travels to Spain Spain