[Diagnosis and Treatment Experience in a Case of Visceral Leishmaniasis Co-infected with HIV]

When visceral leishmaniasis occurs alongside human immunodeficiency virus (HIV) infection, the clinical picture is more severe and the diagnosis and treatment processes are more complex. This case study presents the clinical findings, diagnostic approaches and treatment process of a patient diagnosed with concurrent indigenous visceral leishmaniasis and HIV. A 60-year-old individual who had recently been diagnosed with HIV was admitted for further investigation due to persistent pancytopenia despite receiving antiretroviral therapy. Physical examination, laboratory tests and imaging revealed no findings other than hepatosplenomegaly and generalised lymphadenopathy. Investigations failed to reveal any evidence of common opportunistic infections or HIV-associated malignancies. Upon re-evaluation of the patient's history, it emerged that he lived in a village where there were sheepdogs nearby. Peripheral blood tests revealed positive results for Leishmania IFAT (1/1024), the rK39 rapid antigen test, the Giemsa-stained smear test and polymerase chain reaction (PCR) testing. Promastigote forms were observed in NNN medium and PCR testing identified the species as L.infantum/donovani. Primary treatment with liposomal amphotericin B was administered at a total dose of 50 mg, followed by secondary prophylaxis every four weeks. No clinical or laboratory findings suggestive of relapse were detected during follow-up. The patient died four weeks after the last prophylactic dose due to a myocardial infarction, which was thought to be related to a diagnosis of congestive heart failure. This case is noteworthy for two reasons: it is the second reported case of HIV and visceral leishmaniasis co-infection in Türkiye, and it demonstrates the application of secondary prophylaxis. It makes a unique contribution to the literature in Türkiye by demonstrating the applicability of peripheral blood-based diagnostic approaches and molecular typing in cases of Leishmania co-infection with HIV.