Which of the following statements about visceral leishmaniasis is incorrect: a) there is significant pancytopenia, b) there is marked splenomegaly, c) there is significant hypogammaglobulinemia, d) it is treated with pentavalent antimony salts (e.g., sodium stibogluconate, meglumine antimoniate), e) it is treated with liposomal amphotericin B?

The Correct Answer is C: Significant Hypogammaglobulinemia is INCORRECT

Option C is the incorrect statement because visceral leishmaniasis characteristically causes HYPERgammaglobulinemia, not hypogammaglobulinemia 1.

Why Each Option is Correct or Incorrect:

Option A (Correct Statement): Significant Pancytopenia

This is a correct characteristic of visceral leishmaniasis—the disease causes reduction in all blood cell lines (pancytopenia) as a hallmark feature 2, 3, 4, 5.

Option B (Correct Statement): Marked Splenomegaly

This is a correct characteristic of visceral leishmaniasis—splenomegaly (along with hepatomegaly) is one of the classic triad of findings in VL 2, 4, 5.

Option C (INCORRECT Statement): Significant Hypogammaglobulinemia ⚠️

This is the INCORRECT statement and therefore the correct answer to the question. Visceral leishmaniasis actually causes HYPERgammaglobulinemia (elevated immunoglobulins), not hypogammaglobulinemia 1. This polyclonal B-cell activation with elevated immunoglobulins is a characteristic laboratory finding in VL.

Option D (Correct Statement): Treatment with Pentavalent Antimony Salts

This is a correct treatment option—pentavalent antimonials (sodium stibogluconate and meglumine antimoniate) remain recommended therapy for immunocompetent persons with VL in areas where antimony resistance is low (<10%) 6.

Option E (Correct Statement): Treatment with Liposomal Amphotericin

This is a correct treatment option—liposomal amphotericin B is an established first-line therapy for visceral leishmaniasis with high efficacy rates (92-96%) and has emerged as preferred therapy in many regions 6, 1, 5, 7.