A 66-year-old Italian man, previously treated for visceral leishmaniasis (VL) in 2017 and 2020, presented with a third relapse of VL. His medical history included rheumatoid arthritis, for which he was receiving denosumab (a RANKL inhibitor) and methylprednisolone. Diagnostic bone marrow aspirate revealed numerous Leishmania amastigotes. The patient was successfully treated with liposomal amphotericin B. This case highlights how immunosuppressive therapies, particularly steroids and RANKL inhibitors, can exacerbate VL, leading to severe relapses and complicated disease courses in endemic areas. Clinicians should consider this risk in immunocompromised patients.
Key note: Immunosuppressive agents like steroids and RANKL inhibitors can significantly worsen the outcome and increase relapse risk in visceral leishmaniasis.