Successive pancytopenia as indication for myeloma treatment – a rare case of visceral leishmaniasis
Symptoms and successive pancytopenia in patients with known smouldering multiple myeloma lead unavoidably to the diagnosis of a therapy requiring symptomatic myeloma. Nevertheless, additional diseases can appear in a pre-existing smouldering myeloma and slowly change the physical course of the disease imitating myeloma-related symptoms and organ dysfunction. An unneeded, faulty systemic therapy for multiple myeloma in these cases can have a fatal outcome. This is the first report of a patient with a known smouldering multiple myeloma developing progressive symptoms and pancytopenia due to visceral leishmaniasis. After therapy with a liposomal preparation of amphotericin B all symptoms and the pancytopenia disappeared. An additional disease should be always carefully excluded before initiating a systemic therapy for smouldering myeloma developing indications for systemic therapy.