Atypical Presentation of Visceral Leishmaniasis in a HIV-positive Patient from a Nonendemic Area

Abstract

Visceral leishmaniasis (VL), though widely prevalent in India, is not seen in the Rajasthan where the dry, hot and arid climatic conditions create a hostile environment for the growth of the parasite or its vector, the sandfly. We present a case of VL in a patient co-infected with HIV from this region. A 34-year-old known case of a HIV-positive patient presented to the skin department of our hospital with multiple, nontender, erythematous, papulonodular lesions all over the body for 6 months with history of weight loss and low-grade fever. Important examination findings were pallor, inguinal lymphadenopathy and hepatosplenomegaly. Laboratory findings included anemia, leucopenia, hypergammaglobulinemia and altered leucocytes to erythrocyte ratio. Buffy coat examination and bone marrow aspirates showed the presence of leishman bodies inside monocytes and macrophages respectively as well as extracellularly also. The patient was treated with amphotericin B intravenously and responded well to the treatment.

Changing trends in the epidemiology, clinical presentation, and diagnosis of Leishmania–HIV co-infection in India

“…Vyas and Shah 58 reported probably the first case of visceral and concomitant PKDL in a patient from Rajasthan, an area endemic for CL only. The patient presented with non-tender papulo-nodular lesions all over the body and had hepatosplenomegaly and inguinal lymphadenopathy.…”

“…35 During these early years, several subclinical cases of leishmaniasis 21 started manifesting and various workers started publishing VL-HIV co-infection cases from Bihar and other parts of India. [47][48][49][50][51][52][53][54][55][56][57][58][59][60] Thakur et al 47 reported the first case of HIV-VL co-infection from Bihar who was treated successfully with miltefosine. In 2002, Lanjewar and colleagues 48 reported a series of autopsy findings from 195 AIDS cases in Bombay.…”

“…[52][53][54] A major study finding was that out of 55 VL-HIV cases treated with amphotericin B, 74.5% were cured, 14.5% relapsed, and 10.9% died within 2 years. Others are mostly case reports [55][56][57][58][59][60] (Table 1). Thus, a total of 89 published records of VL-HIV cases from India were identified to the date at which this manuscript was submitted.…”