Navigating Diagnosis and Treatment Dilemmas in Visceral Leishmaniasis Reactivation in a HIV-Positive Patient

Reactivation of visceral leishmaniasis (VL) in human immunodeficiency virus (HIV)-positive patients poses complex management challenges, requiring tailored treatment approaches and robust follow-up strategies. There are very few case reports of visceral leishmaniasis (VL) published in Sri Lanka as of today. Here, we present a case of a 38-year-old, HIV-positive male who was treated for a reactivation of VL. He presented with a prolonged febrile illness without an identifiable infection focus. The evaluation confirmed VL reactivation. Using current evidence-based guidelines, our patient was treated with intravenous liposomal amphotericin B and achieved a parasitological cure.  By exploring the challenges associated with managing VL among HIV-positive individuals, we emphasize the importance of reliable follow-up protocols and investigations to assess treatment success, ensuring optimal patient outcomes.