Visceral and cutaneous leishmaniasis in a person living with HIV

Leishmaniasis, the third most common parasitic infection in persons living with HIV, typically presents in cutaneous, mucocutaneous, or visceral forms. This case report describes a 24-year-old male with advanced HIV/AIDS (CD4+ count 3 cells/mm³) who presented with neurological deterioration due to cerebral toxoplasmosis. During hospitalization, he developed atypical genital ulcers and persistent pancytopenia. Bone marrow examination revealed amastigotes consistent with Leishmania spp., indicating concurrent visceral and mucocutaneous leishmaniasis. Treatment with liposomal amphotericin B followed by miltefosine resulted in clinical improvement of the genital ulcers. This case highlights the atypical presentation of leishmaniasis in a patient living with HIV, deviating from classic descriptions and underscoring the diagnostic challenges. The presence of Leishmania amastigotes in the bone marrow, coupled with unusual cutaneous manifestations, emphasizes the need for a high index of suspicion for opportunistic infections in patients living with HIV/AIDS with unexplained findings, even without a history of travel to endemic areas. Timely diagnosis through bone marrow examination and appropriate multi-drug therapy are crucial for managing such complex co-infections.