<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0375-0760</journal-id>
<journal-title><![CDATA[Revista Cubana de Medicina Tropical]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Cubana Med Trop]]></abbrev-journal-title>
<issn>0375-0760</issn>
<publisher>
<publisher-name><![CDATA[Centro Nacional de Información de Ciencias Médicas]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0375-07602022000200021</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Recurrent American visceral leishmaniasis in a kidney transplant recipient: A case report]]></article-title>
<article-title xml:lang="es"><![CDATA[Leishmaniasis visceral americana recidivante en un trasplantado renal: reporte de caso]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alexandre Rancan]]></surname>
<given-names><![CDATA[Eduardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Perinetti Alves Martins]]></surname>
<given-names><![CDATA[Cintia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[de Melo Araújo]]></surname>
<given-names><![CDATA[Ivan]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pavanetti]]></surname>
<given-names><![CDATA[Luiz Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aparecida Ribeiro]]></surname>
<given-names><![CDATA[Camila]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Buzinaro Suzuki]]></surname>
<given-names><![CDATA[Rodrigo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Perinetti Alves Martins]]></surname>
<given-names><![CDATA[Luciamáre]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Faculdade de Medicina de Marília (Famema)  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Brasil</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Centro Universitário de Adamantina (UNIFAI)  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Brasil</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidade de Marília (UNIMAR)  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Brasil</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2022</year>
</pub-date>
<volume>74</volume>
<numero>2</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S0375-07602022000200021&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S0375-07602022000200021&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S0375-07602022000200021&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: American visceral leishmaniasis (AVL) is a neglected tropical disease that causes severe conditions in immunosuppressed patients such as kidney transplant recipients. In these individuals, the infection can be associated with renal graft dysfunction and loss.  Objective: To describe the case of a female kidney transplant recipient assisted at the Hospital das Clínicas of Marília Medical School, who died probably as a result of hemodialysis-related complications after graft loss due to treatment toxicity of her underlying disease.  Clinical case: A 22-year-old patient, resident in an endemic region of AVL, immunosuppressed due to renal transplantation, who evolved to graft loss after successive relapses, treatment and drug prophylaxis for AVL. With the interruption of immunosuppressive therapy and return to dialysis, amastigote forms were not observed in a bone marrow aspirate smears. However, after one year, she progressed to death due to a cerebrovascular accident resulting from comorbidities.  Conclusions:  It is described a rare case of successive relapses of AVL and difficult medical decision due to the therapeutic impasse between the use of immunosuppressive drugs for renal graft maintenance and treatment for the parasitic disease. The parasitological control was observed with the immunosuppression suspension, demonstrating the importance of a competent immune system and the adjuvant of specific drugs for the disease control.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: La leishmaniasis visceral americana (LVA) es una enfermedad tropical desatendida causante de cuadros graves en pacientes inmunodeprimidos, tales como los trasplantados renales. En estos individuos, la infección puede asociarse a la disfunción y pérdida del injerto renal.  Objetivo: Describir el caso de una paciente con transplante renal, atendida en el Hospital Clínico de la Facultad de Medicina de Marília, que murió probablemente como resultado de complicaciones por una hemodiálisis después de la pérdida del injerto por toxicidad del tratamiento de su enfermedad.  Caso clínico: Paciente de 22 años, residente en una región endémica para LVA, con inmunosupresión debido a trasplante renal, que evolucionó con pérdida del injerto después de sucesivas recidivas, tratamiento y profilaxis medicamentosa contra LVA. Con la interrupción de la terapia inmunosupresora y el retorno a la terapia dialítica, no se observaron formas amastigotes en la muestra de aspirado de médula ósea. Sin embargo, después de un año, evolucionó a muerte por accidente vascular encefálico resultante de comorbilidades.  Conclusiones: Se describe un caso raro de sucesivas recidivas de AVL y la toma de decisiones médicas difíciles debido a la disyuntiva terapéutica entre el uso de medicamentos inmunosupresivos para mantener el injerto renal y el tratamiento antiparasitario. El control parasitológico se logró con la suspensión de la inmunosupresión, lo que demuestra la importancia de un sistema inmunocompetente y la adyuvancia de drogas específicas para el control de la enfermedad.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[visceral leishmaniasis]]></kwd>
<kwd lng="en"><![CDATA[immunosuppression]]></kwd>
<kwd lng="en"><![CDATA[kidney transplantation]]></kwd>
<kwd lng="en"><![CDATA[hypertension]]></kwd>
<kwd lng="en"><![CDATA[dialysis]]></kwd>
<kwd lng="es"><![CDATA[leishmaniasis visceral]]></kwd>
<kwd lng="es"><![CDATA[inmunosupresión]]></kwd>
<kwd lng="es"><![CDATA[trasplante de riñón]]></kwd>
<kwd lng="es"><![CDATA[hipertensión]]></kwd>
<kwd lng="es"><![CDATA[diálisis]]></kwd>
</kwd-group>
</article-meta>
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<page-range>142-55</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ghoshal]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Freedman]]></surname>
<given-names><![CDATA[BI]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Mechanisms of Stroke in Patients with Chronic Kidney Disease]]></article-title>
<source><![CDATA[Am J Nephrol]]></source>
<year>2019</year>
<volume>50</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>229-39</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
