Atypical cutaneous histological features of visceral leishmaniasis in acquired immunodeficiency syndrome

Cutaneous lesions in Mediterranean visceral leishmaniasis (VL) are very unusual, except for the presence of Leishmania organisms in cutaneous Kaposi's sarcoma in patients with acquired immunodeficiency syndrome (AIDS). We have identified two unusual cutaneous histological features of VL in three patients with AIDS not described previously; two had "silent leishmaniasis," and in the third, Leishmania organisms were present in sweat ducts, suggesting transepithelial elimination through eccrine sweat glands and/or eccrine epithelial tropism.