From Pancytopenia to Diagnosis: Visceral Leishmaniasis Identified Through Primary Care Assessment

Visceral leishmaniasis is a potentially life-threatening systemic parasitic infection caused by protozoa of the genus Leishmania and transmitted by sandflies. Although uncommon in Portugal, it should be considered in the differential diagnosis of prolonged fever associated with pancytopenia and hepatosplenomegaly, even in immunocompetent individuals. We report a case of a previously healthy young adult who initially presented to an urgent Family Medicine consultation in primary care, where pancytopenia was identified and prompted timely referral to secondary care. Diagnosis was confirmed by the detection of Leishmania amastigotes in bone marrow aspirate during haematological investigation. Treatment with liposomal amphotericin B resulted in complete clinical and laboratory recovery. This case highlights the importance of careful primary care assessment, recognition of red flags, and effective coordination between primary and secondary care in non-endemic settings.