Diffuse cutaneous leishmaniasis and HIV co‐infection: A case report and review of the literature

Abstract

Diffuse cutaneous leishmaniasis and human immunodeficiency virus (HIV) co-infection is an emerging issue in both endemic and non-endemic regions. We report a case of a 37-year-old Nicaraguan American male with HIV/AIDS who presented with a diffuse papulonodular eruption on the trunk and lower extremities. Punch biopsy revealed abundant amastigotes with transepidermal and transfollicular elimination, as well as superficial perivascular inflammation. The patient was found to have diffuse cutaneous leishmaniasis with Leishmania infantum/chagasi, and he was treated with liposomal amphotericin B with initial resolution. A subsequent relapse with concern for possible visceral involvement was treated with further amphotericin B and miltefosine with resolution of his skin lesions. Leishmaniasis in the setting of HIV can lead to atypical clinical characteristics, and the interaction between the two pathogens is not well understood. Unique histopathologic findings have yet to be well described. Transepidermal and transfollicular elimination of amastigotes is a rare finding seldom reported in the literature and may reflect high parasite burden as can be seen in immunocompromised patients. Recognition of the variable presentations and histopathologic findings of Leishmania spp. and HIV co-infection is helpful even in non-endemic regions. This article is protected by copyright. All rights reserved.