Leishmaniasis cutaneous-visceral, suspect it to diagnose it

In the last 25 years there has been a global increase in cases of leishmaniasis. It is postulated that climate change, global increase in temperature, massive migrations from the countryside to the city and agro-industrial projects (creation of swamps, irrigation systems, water well formation...) enhance the emergence of reservoirs of sand-fly mosquitoes, which are the vectors of this disease. It should be noted that in the Valencian Community, an endemic area, the incidence rate has suffered a considerable increase in recent years. We describe a 2-year-old patient who presented clinical and analytical findings compatible with visceral leishmaniasis (fever, splenomegaly and pancytopenia), with the antecedent, several months before, of a cutaneous leishmaniasis. There are few cases in the literature that describe concomitant cutaneous and visceral leishmaniasis, a fact that gives importance to our case. The immaturity of the cellular immune response at that age could be the cause of this atypical presentation.