Visceral Leishmaniasis in Somalia: Diagnosis and Management of a Classic Case in a Resource-Limited Endemic Setting

Visceral Leishmaniasis (VL), a severe systemic neglected tropical disease (NTD) caused by Leishmania donovani complex protozoa, poses a significant public health threat, particularly in East Africa, where it is fatal if untreated. Somalia is known to be endemic, but the true burden and programmatic challenges are poorly documented due to long-standing conflict, population displacement, and a fragmented, resource-constrained health system. We report the case of a 40-year-old male farmer from Borama, Awdal region (Somaliland), presenting with a 20-day history of intermittent high-grade fever, chills, progressive weakness, anorexia, and vomiting. Physical examination revealed marked hepatosplenomegaly and pallor. Laboratory investigations showed moderate anemia (Hemoglobin 9.4 g/dL), thrombocytopenia (114,000/μL), and a highly elevated ESR (50 mm/h). Mild hyperbilirubinemia was noted, likely secondary to hemolysis. Tests for malaria, tuberculosis, and enteric fever were negative. Definitive parasitological confirmation was not feasible due to local resource limitations. A rapid diagnostic test (RDT) for VL based on rK39 antigen-Kalazar Detect (Human) Rapid Test-was positive. Ultrasound confirmed significant hepato-splenomegaly. Based on the clinical presentation, positive rK39 RDT, and exclusion of other etiologies, a diagnosis of Visceral Leishmaniasis was established. The patient was treated according to WHO regional guidelines with Sodium Stibogluconate (SSG, 20 mg/kg/day) and Paromomycin (PM, 15 mg/kg/day) for 17 days. The patient tolerated treatment well; the fever resolved within five days. At one-week post-therapy follow-up, he showed significant clinical improvement. This case highlights the classic presentation of VL in a fragile setting and underscores the critical role of RDTs where parasitological confirmation is unavailable. It demonstrates the feasibility of the WHO-recommended SSG+PM combination therapy despite systemic challenges.