An unusual presentation of leishmaniasis in a human immunodeficiency virus-positive individual Open Access

Abstract

Introduction:

Leishmaniasis is a neglected tropical disease caused by vector-borne protozoa of the genus . Cutaneous and mucocutaneous forms result in disfiguration or mutilation, whilst visceral leishmaniasis (VL) affects multiple organs and is fatal if untreated. Notably, are capable of establishing a chronic infection, which may reactivate years after initial infection when the host becomes immune-suppressed.

Case Presentation:

A 24-year-old human immunodeficiency virus (HIV)-positive male presented for excision of anal condylomas. At the time of his current condyloma excision, the patient had no additional symptoms or cutaneous findings, but was noted to have been only intermittently compliant with his antiretroviral therapy. Microscopic examination of the haematoxylin and eosin-stained anal condyloma tissue revealed koilocytic change, ulceration and brisk histiocytic inflammation containing numerous small intracellular bodies suggestive of amastigotes. A bone marrow biopsy was performed and demonstrated similar intracellular forms. Anal condyloma tissue and bone marrow aspirate were sent to the Centers for Disease Control and Prevention's Parasitic Diseases Branch for confirmation of and speciation. Specific immunohistochemical staining for in the tissue section was positive and the species was confirmed as by PCR. Subsequently, the patient resumed highly active antiretroviral therapy and received anti- therapy.

Conclusion:

Whilst the presentation of VL in HIV-positive patients is often similar to those without HIV, here we describe an unusual initial presentation of leishmaniasis in an HIV-positive patient where the parasite was found in an anal condyloma. VL is a critical diagnosis that should be considered and pursued when leishmaniasis is encountered in seemingly illogical clinical settings.

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2016-02-05
2024-03-19
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References

  1. Balkhair A., Ben Abid F. 2008; Gastric and cutaneous dissemination of visceral leishmaniasis in a patient with advanced HIV. Int J Infect Dis 12:111–113 [View Article][PubMed]
    [Google Scholar]
  2. Bielory B. P., Lari H. B., Mirani N., Kapila R., Fitzhugh V. A., Turbin R. E. 2011; Conjunctival squamous cell carcinoma harboring Leishmania amastigotes in a human immunodeficiency virus-positive patient. Arch Ophthalmol 129:1230–1231 [View Article][PubMed]
    [Google Scholar]
  3. Calza L., D'Antuono A., Marinacci G., Manfredi R., Colangeli V., Passarini B., Orioli R., Varoli O., Chiodo F. 2004; Disseminated cutaneous leishmaniasis after visceral disease in a patient with AIDS. J Am Acad Dermatol 50:461–465 [View Article][PubMed]
    [Google Scholar]
  4. Colebunders R., Depraetere K., Verstraeten T., Lambert J., Hauben E., Van Marck E., Maurer T., Bañuls A. L., Dujardin J. 1999; Unusual cutaneous lesions in two patients with visceral leishmaniasis and HIV infection. J Am Acad Dermatol 41:847–850 [View Article][PubMed]
    [Google Scholar]
  5. Dochez C., Bogers J., Verhelst R., Rees H. 2014; HPV vaccines to prevent cervical cancer and genital warts: an update. Vaccine 32:1595–1601 [View Article][PubMed]
    [Google Scholar]
  6. Forsyth S., Lawn S., Miller R., Fernando J., Lockwood D., Vega-Lopez F. 2003; Multiple dermatofibroma-like lesions in a human immunodeficiency virus-positive patient coinfected with visceral leishmaniasis. Br J Dermatol 148:185–187 [View Article][PubMed]
    [Google Scholar]
  7. González-Beato M. J., Moyano B., Sanchez C., González-Beato M. T., Perez-Molina J. A., Miralles P., Lazaro P. 2000; Kaposi's sarcoma-like lesions and other nodules as cutaneous involvement in AIDS-related visceral leishmaniasis. Br J Dermatol 143:1316–1318 [View Article][PubMed]
    [Google Scholar]
  8. Jarvis J., Lockwood D. 2013; Clinical aspects of visceral leishmaniasis in HIV infection. Curr Opin Infect Dis 26:1–9 [View Article][PubMed]
    [Google Scholar]
  9. Lopez-Medrano F., Costa J. R., Rodriguez-Peralto J., Aguado J. 2007; An HIV-positive man with tattoo induration. Clin Infect Dis 45:267–268 [View Article][PubMed]
    [Google Scholar]
  10. Palefsky J. 2009; Human papillomavirus-related disease in people with HIV. Curr Opin HIV AIDS 4:52–56 [View Article][PubMed]
    [Google Scholar]
  11. Santos-Oliveira J., Da-Cruz A., Pires L., Cupolillo E., Kuhls K., Giacoia-Gripp C., Oliveira-Neto M. 2011; Atypical lesions as a sign of cutaneous dissemination of visceral leishmaniasis in a human immunodeficiency virus-positive patient simultaneously infected by two viscerotropic Leishmania species. Am J Trop Med Hyg 85:55–59 [View Article][PubMed]
    [Google Scholar]
  12. Saporito L., Giammanco G., De Grazia S., Colomba C. 2013; Visceral leishmaniasis: host–parasite interactions and clinical presentation in the immunocompetent and in the immunocompromised host. Int J Infect Dis 17:e572–e576 [View Article][PubMed]
    [Google Scholar]
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