Disseminated Leishmaniasis With Immune Reconstitution Inflammatory Syndrome–associated Pneumocystis Pneumonia in a Human Immunodeficiency Virus–infected Patient With First-line Antiretroviral Therapy Failure

Abstract

Abstract Disseminated atypical leishmaniasis is a stage IV defining illness in people with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. Although visceral leishmaniasis is endemic in some regions of India, atypical disseminated leishmaniasis is not reported frequently. Patients of visceral leishmaniasis in HIV/acquired immunodeficiency syndrome present with atypical manifestations like involvement of upper or lower gastrointestinal tract, lungs, pleura, liver, kidney, skin, and peritoneum and have chronic progression with relapses irrespective of treatment given. We hereby report a case of atypical disseminated leishmaniasis in an HIV-positive patient, who also developed Pneumocystis pneumonia as a part of immune reconstitution syndrome after failure of first-line antiretroviral therapy. Our patient also had involvement of gastrointestinal tract and lymph nodes which has rarely been reported from Indian subcontinent.