Cases of visceral leishmaniasis in children: a difficult path to diagnosis

This article presents two clinical cases of visceral leishmaniasis (VL) in children under 5 years of age, one of which was complicated by hemophagocytic syndrome (HPS). Both cases illustrate the diagnostic challenges encountered in non-endemic regions, where VL may mimic malignancies, hematologic, or infectious diseases. The authors describe the diagnostic algorithm involving bone marrow microscopy, molecular (PCR) testing, and differential diagnosis. The treatment strategies included amphotericin B therapy and immunomodulatory treatment (dexamethasone and intravenous immunoglobulin) for VL with HPS complications. The article emphasizes the need to raise clinical awareness in non-endemic areas and to expand access to sensitive diagnostic methods to ensure timely identification of VL and prevent severe outcomes.