An Unwelcome Synergy: Leishmaniasis and HIV

Abstract

m PRESENTATION When patients with HIV/AIDS travel to the United States from other parts of the world, they can bring more exotic opportunistic infections with them. In November 2010, a 29-year-old man presented to the emergency department after a few days of fever, chills, diffuse abdominal pain, vomiting, and dysuria. For the previous 6 months, he also had experienced diarrhea and unintentional weight loss, totaling 40 lb (18 kg). Two weeks prior to his acute presentation, he had been treated for pyelonephritis at an outside institution, where he also had reported 2-3 weeks of worsening diarrhea. The patient had been diagnosed with HIV/AIDS in 2007. At the time of diagnosis, he was treated for cerebral toxoplasmosis with pyrimethamine, sulfadiazine, and leucovorin. In 2008, he was treated with intraocular ganciclovir for cytomegalovirus retinitis. Since his diagnosis, he had been intermittently adherent to antiretroviral therapy with Atripla, (Bristol-Myers Squibb, New York, NY), a combination of efavirenz, emtricitabine, and tenofovir disoproxil fumarate and to his maintenance therapy for the aforementioned opportunistic infections. He also had a history of pancytopenia, diagnosed in 2008; a bone marrow biopsy was hypocellular with poorly-formed noncaseating granulomas. His attendance at follow-up visits was erratic, preventing further workup. Born in Honduras, the patient worked on a farm, and moved to the United States in 2004, where has worked in construction. He had had a single male sexual contact and multiple female sexual partners. Condom use was inconsistent.