Coinfection of Visceral Leishmaniasis and Mycobacterium in a Patient With Acquired Immunodeficiency Syndrome

Abstract

We report a case of coinfection of visceral leishmaniasis and Mycobacterium avium-intracellulare in the same lesions in the small bowel and bone marrow of a 33-year-old man with acquired immunodeficiency syndrome who complained of abdominal pain and chronic diarrhea. The duodenal mucosa and bone marrow biopsy specimens showed numerous foamy macrophages packed with two forms of microorganisms that were identified histologically and ultrastructurally as Leishmania and Mycobacterium species. Visceral leishmaniasis is rarely suspected in patients residing in nonendemic countries including the United States. It should be included in the differential diagnosis for opportunistic infection in patients with acquired immunodeficiency syndrome. An appropriate travel history is important. To our knowledge, this is the first reported case showing coinfection of visceral leishmaniasis and Mycobacterium avium-intracelluulare in the same lesion in a patient with acquired immunodeficiency syndrome.

Understanding Human Leishmaniasis:The Need for an Integrated Approach

“…Moreover, it seems important to note and to consider the cases of co-infection of Leishmania with other pathogens. This is relatively frequent according to the literature and various pathogens in association with Leishmania such as Mycobacterium tuberculosis [94,386], Trypanosoma cruzi [30], Salmonella and Schistosoma [109], and of course HIV (for reviews see [97,103,234,268]) have been studied. Furthermore, in some cases, these co-infections can produce unusual clinical forms of leishmaniasis [66,75].…”