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January 10, 1948


JAMA. 1948;136(2):111-112. doi:10.1001/jama.1948.02890190039010

In this issue of The Journal, page 81, appears a case report by Levy and Yiengst1 of kala-azar in New York City. This patient had been away from endemic areas of visceral leishmaniasis for seventeen to nineteen months, an incubation period not unusual in this disease. Preliminary physical examination revealed vague abdominal tenderness, loss in weight, fever and mild reddening of the pharynx but was otherwise negative. Observations of this sort might easily indicate any one of many other maladies common to the United States. Fortunately in this case the necessary medical curiosity combined with excellent laboratory facilities determined correct diagnosis and provided for proper treatment.

Without typical symptoms, differential diagnosis included consideration of malaria, leukemia, bacillary dysentery, typhoid, paratyphoid, undulant fever, typhus, tularemia and others. Diagnosis became apparent only after the second biopsy of bone marrow. Adequate laboratory facilities such as are implied in the foregoing account are